The Changes And Significances In Blood Uric Acid, Homocysteine And Hypersensitive C Reactive Protein Of Peritoneal Dialysis Patients

Objective:Detect the levels of serum uric acid (UA), homocysteine (Hcy), andhigh-sensitivity C-reactive protein (Hs-CRP) in continuouse ambulatoryperitoneal dialysis patients (CAPD). Explore the influence of peritonealdialysis and the relationship between clinical indicators.Method:1Research objects: Selection the88cases of end stage renal disease(ESRD) without dialysis patients and the106cases of CAPD patients for morethan3months.2Groups: Non-dialysis group: ESRD without dialysis patients,88cases, males51cases and females37cases, age:17-78years old, Averageage46.3±16.6years; CAPD group:106cases, male50cases and female56cases,age:15-74years, Average age45.6±14.7years; the healthy controlgroup:23cases, males12cases and females11cases, age17-64years old,average age42.4±12.4years.3Mensuration of biochemical parameters：Therecords of general (name, gender, age, height, weight, primary disease,previous cardiovascular events, BMI, blood pressure, dialysis program, bloodurea nitrogen clearance (Kt/V), residual renal function (RRF), etc. Uric acid,Hcy and Hs-CRP were determinated by colorimetry, immune turbidimetry andenzymatic determination.Complete the determination of blood count, liverfunction, kidney function, serum lipids, serum glucose, serum calcium, serumphosphorus, iPTH and other biochemical indicators simultaneously.Results:1The general Information of patients： There was not significant difference inage, sex and BMI among the groups. The levels of iPTH had no significant difference between CAPD group and Non-dialysis group. The level of bloodpressure (137.41±19.41vs155.73±24.9,P <0.05),BUN(22.47±11.56vs30.15±11.58,P<0.05), serum phosphorus (1.57±1.33vs1.89±0.54,P<0.05), calcium-Phosphorus product (40.15±13.28vs44.59±15.32, P <0.05) and CHOL (4.81±1.08vs4.09±1.16,P<0.05) were higher in CAPD group and Non-dialysis groupthan the control group. The level of systolic blood pressure, BUN, serumphosphorus, calcium-phosphorus product in CAPD group were lower thanthose in Non-dialysis group, while CHOL was higher than Non-dialysis group,and the difference was statistically significant (P <0.05). The level of eGFR,ALB, Hb and serum calcium in CAPD group and Non-dialysis group werelower than those in the control group. The level of Hb(98.03±21.14vs79±19.36, P <0.05) was higher in CAPD group than in Non-dialysis group, whilethe level of eGFR(3.9±1.07vs6.4±2.82,P<0.05) was lower than it inNon-dialysis group and the difference is statistically significant (P<0.05). Thedifference of iPTH (272±174.35vs307±195.22,P＞0.05)is not statisticallysignificant (P＞0.05) in CAPD group and Non-dialysis group. Thepercentages of CAPD group and ESRD patients with previous history ofcardiovascular disease were13.2%and19.3%respectively.2The level of blood UA, Hcy and Hs-CRP among groups：The level of bloodUA（491.3±162.25vs374.96±76,P<0.05）, Hcy （22.05±13.6vs29.93±21.66,P<0.05）and Hs-CRP（2.05±1.25vs5.1±2.3P<0.05）in Non-dialysis group andCAPD group were higher than those in the healthy control group, and thedifference was statistically significant (P <0.05). The level of UA, Hcy andHs-CRP in CAPD group were lower than in Non-dialysis group and thedifference statistically significant (P <0.05).3The changes about the level of blood UA, Hcy and Hs-CRP after peritonealdialysis: After peritoneal dialysis, the level of blood UA（374.72±96.07）, Hcy（21.3±7.78）and Hs-CRP（1.55±0.26）were lower than UA（502.58±128.28）,Hcy（28.49±16.34）and Hs-CRP（3.55±1.94）after peritoneal dialysis and thedifference was statistically significant（P﹤0.05, P﹤0.01）. 4Relationship between the level of UA,Hcy and Hs-CRP and atheroscleroticcardio vascular disease（ASCVD)： the compare between Peritoneal dialysispatients with previous history of cardiovascular disease and no history ofcardiovascular disease: The level of serum uric acid（427.07±63.05vs364.38±74.77, P﹤0.05), homocysteine（33.7±13.8vs19.8±8.48,P﹤0.01）and highsensitivity C-reactive protein（5.1±3.1vs2±1.28,P﹤0.01）, all of them in aincreasing trend，and the difference was statistically significant (P <0.05, P<0.01).5Correlation analysis results:5.1UA had a significant positive correlation with Hs-CRP(r0.271,P0.005),ALB (r0.072,P0.037), BUN (r0.338,P﹤0.001), serum phosphorus (r0.293, P0.001), systolic blood pressure(r0.193,P0.004), and calcium-phosphateproduct(r0.18,P0.064),and had a significant nagtive correlation with Kt/V(r-0.238,P0.002).5.2Hcy had a significant positive correlation with BMI (r0.474,P<0.001),ALB(r0.326,P﹤0.001), systolic blood pressure (r0.247,P﹤0.001) and Hb(r0.217,P0.013).5.3Hs-CRP had a significant positive correlation with UA (r0.271,P0.005),BUN (r0.218,P0.013), age (r0.288,P0.002), BMI (r0.186,P0.032) anddialysis time (r0.215,P0.019), while it had a significantly negative correlationwith ALB (r-0.191,P0.004) and diastolic blood pressure (r-0.171,P0.009).Conclusions:1The levels of serum uric acid,Hcy and Hs-CRP were heightensignificantly in ESRD, CAPD can effectively reduce of levels of serum uricacid and Hcy in ESRD.2CAPD can effectively improve anemia, malnutrition and micro-inflammatory state of ESRD patients.3The level of uric acid, Hcy and hs-CRP in CAPD patients is closelyrelated to cardiovascular complications.