Effects Of Different Dialysis Methods On The Removal Of Toxins And Inflammatory Reaction

Objective The aim of this study is to compare the effect of different modes of dialyers and different membrane materials on the removal of uremic toxic substances and inflammation status and the oxidative stress in patients with maintenance hemodialysis(MHD).Methods 60 MHD patients were randomly assigned into 4 groups: ⑴low-flux diacetate fiber membrane group(11 people, CA-HP-170 low-flux dialyzer, the dialysis membrane area is 1.7 m2, the ultrafiltrate coefficient is 9.7ml/h·mm Hg). ⑵low-flux polysulfone membrane group(10 people, F6 HPS low-flux dialyzer, the dialysis membrane area is 1.3 m2, the ultrafiltrate coefficient is 5.5ml/h·mm Hg). ⑶ high-flux polysulfone membrane group(24 people, Ts-1.3S high-flux dialyzer, the dialysis membrane area is 1.3 m2, the ultrafiltrate coefficient is 44ml/h·mm Hg). ⑷ high-flux hemodialysis combined with hemodiafiltration group(HD+HDF)(15 people, The dialyzer they used was same to the one which highflux polysulfone membrane group used).The level of Serum creatnine(Scr), blood urea nitrogen(BUN), beta 2-microglobulin(β2-MG), intact PTH(i PTH), high-sensitive C reactive protein(hs-CRP), interleukin-6(IL-6), advanced oxidation protein products(AOPP)and malondialdehyde(MDA) were detected.Result In low-flux polysulfone membrane group and low-flux diacetate fiber membrane group, IL-6, hsCRP, AOPP and MDA increased compared with the previous levels before the experiment(P<0.05).β2-MG and i PTH didn’t significantly decrease at the end of 3rd and 6th month(P>0.05). There are significant differences in the levels of β2-MG, i PTH, IL-6, MDA and AOPP in high-flux polysulfone membrane group at the end of 6th month(P<0.05), but the levels of MDA and AOPP didn’t decline obviously after 3 months’ treatment(P>0.05). All indicators decreased significantly in HD+HDF group with the extension of the treatment time(P<0.05). There was no significant change in the serum levels of Scr and BUN among 4 groups(P>0.05).Conclusion ⑴Compared with the low-flux hemodialysis, high-flux hemodialysis and HD+HDF can increase the removal of large and medium molecular toxins and can also relief the inflammation status and oxidative stress state in patients with hemodialysis. And the effect of HD+HDF may be better than that of high-flux hemodialysis.⑵Compared with the diacetate fiber membrane,the polysulfone membrane has less influence on the inflammation status and oxidative stress of uremic patients.