Influence Of Blood Purification Modality On The Efficacy Of Erythropoietin In Patients On Maintenance Hemodialysis

Objective：To compare the clearance ability for middle molecular uremic toxins, likeinflammatory mediators and parathyroid hormone (PTH),in maintenancehemodialysis patients (MHD) of three blood purification modalities and also observethe influence of above factors on the curative effect of recombinant humanerythropoietin (r-HuEPO)in this study. In order to choose the best blood purificationmodalities for the MHD patients to improve the quality of the their survival.Methods：Select54cases of patients with maintenance hemodialysis in our hospital, thenrandomly divided into three groups,namely hemodialysis (HD)group,hemodiafiltration (HDF) group,hemodialysis+hemoperfusion (HD+HP)group,eighteen in each group. Routine blood test was checked every4weeks andEPO dosage according to the correction of anemia adjusted.The follow-up lasted forthree months. The level of C-reactive protein (CRP),PTH,interleukin-6(IL-6) andindicators of renal anemia were measured at the beginning and just after thetrial,while EPO amount and hematocrit (Hct) ratio (EPO/Hct) was defined as EPOresistance indicators.Results：Before and after the treatment,comparising in group,EPO/Hct,CRP,IL-6,PTH ofpatients in HDF and HD+HP group decreased obviously （P<0.05), while nosignificant change in each indicators was observed in HD group （P>0.05）;Comparising between groups, the change of EPO dosage,EPO/Hct,CRP,IL-6andPTH have statistically significant(P<0.05),the EPO dosage, EPO/Hct, CRP, IL-6andPTH decreased obviously in HD+HP and HDFgroup(P<0.05)and the CRP,IL-6concentration was evidently lower in HD+HP group (P=0.032;P=0.032).correlationanalysis found that CRP, IL-6and PTH were associated with the EPO/Hct ratio.Conclusions：Different ways of blood purification have different removal effects on CRP, IL-6and PTH.Compared with the pure HD treatment, HDF and HD+HP treatments caneffectively remove the medium and large molecules toxins,such as CRP, IL-6, PTH. Meanwhile,HDF and HD+HP can improve the treatment efficacy and reduce dosageof EPO in uremic patients, while the mechanism probably has part relationship withthe improvement of hyperparathyroidism and micro-inflammation status of thepopulation.