Association Between 25-hydroxyvitamin D Level And Inflammatory And Nutritional Factors In Patients Undergoing CAPD

Objective:Continuous ambulatory peritoneal dialysis is the basic method for kidney replacement therapy in patients with end stage renal disease.Despite being a life-saving treatment,the rate of mortality in patients under CAPD is elevated as peritoneal dialysis time increases,inflammation is one of the recognized non-traditional risk factors that contribute to its high mortality,Interleukin-6?IL-6?,tumor necrosis factor-??TNF-??,and high sensitivity c-reactive have been identified in inflammation markers discovered so far,and it is commonly used clinically.an indicator for detecting inflammation and predicting adverse clinical outcome in patients with CAPD.In recent years,it has also been found that malnutrition is also one of the important complications of patients with CAPD,inflammation is more common in malnourished CAPD patients,there is a close relationship between malnutrition and inflammation.In addition,there is a general lack of 25?OH?D in patients with prolonged peritoneal dialysis,25?OH?D is closely related to the occurrence of various inflammatory diseases,by monitoring 25?OH?D levels and related inflammatory factors in patients with CAPD,predict their possible complications and intervene.This study was to monitor the level of inflammatory factors and nutritional indicators in patients with CAPD,to investigate the correlation between serum 25?OH?D levels and inflammatory factors and nutritional status in CAPD patients,therefore,it provides a new intervention target for the prevention and treatment of complications in patients with CAPD,so that patients with CAPD can benefit from long-term survival.Method:1.Subjects:A total of 89 patients undergoing CAPD treatment for chronic renal failure were included,All patients were treated with peritoneal dialysis using non-low calcium Baxter dialysate for more than 3 months,and the daily dialysis dose was above 6L.according to 25?OH?D levels were divided into three groups,namely the normal vitamin D group?N?12 cases,vitamin D deficiency group?I?26 cases,vitamin D deficiency group?L?51 cases.2.General information recording inductees,including gender,age,duration of dialysis,primary disease,whether the recent infection,with or without consolidation diabetes.3.Laboratory indicators:Measures serum albumin?Alb?,prealbumin?PA?,calcium?Ca?,phosphorous?P?,parathyroid glands Parathyroid hormone?PTH?and hs-CRP in the laboratory of our hospital,and calculate the ratio of neutrophils to lymphocytes?NLR?;serum 25?OH?D,interleukin-6 and tumor necrosis factor-?levels were measured by ELISA.4.Subjective nutritional status assessment:The modified subjective comprehensive nutrition assessment method?MQSGA?consists of seven items^[1],each part is different according to different conditions?from light to heavy 1-5 minutes?,and subjectively evaluates the patient's nutritional status based on the total score.5.Statistical methods:Multiple sample comparisons were compared using analysis of variance,If P<0.05 use the LSD method to perform a pairwise comparison,statistical software was used for statistical analysis,and correlation analysis was performed using Pearson correlation analysis.Results:1.Comparison of general data among the selectedThere was no difference in age,dialysis time,and diabetes status between the three groups,the difference was not statistically significant?P>0.05?.2.Comparison of serum Ca,P and PTH among three groups of patientsThere was no significant difference in serum Ca,P,and PTH levels between the N,I and L groups?P>0.05?.3.Comparison of Inflammation Index?hs-CRP,IL-6,TNF-?and NLR?among Three Groups of PatientsCompared with the N group,the levels of serum hs-CRP,IL-6,TNF-?and NLR were significantly higher in the I group and the L group?P<0.05?;The levels of serum hs-CRP,IL-6,TNF-?and NLR in the I group were lower than those in the L group?P<0.05?.4.Comparison of nutritional indicators?Alb,PA and MQSGA?among the three groups of patientsCompared with the N group,the levels of serum Alb,PA,and MQSGA scores in the I group decreased?P<0.05?.Compared with I group,the levels of Alb,PA and MQSGA scores in the L group were further decreased?P<0.05?.5.Correlation analysis5.1 Correlative analysis of serum 25?OH?D level and inflammatory index?hs-CRP,IL-6,TNF-?and NLR?Negative correlation between serum 25?OH?D level and serum hs-CRP,IL-6,TNF-?and NLR level?r=-0.639,-0.701,-0.875,-0.571,P<0.001?.5.2 Correlative analysis of serum 25?OH?D levels and nutritional indicators?Alb,PA and MQSGA?Serum 25?OH?D levels were positively correlated with Alb and PA levels?r=0.875,0.852,P<0.001?and negatively correlated with MQSGA score?r=-0.885,P<0.001?.5.3 Correlation analysis of inflammatory markers?hs-CRP,IL-6,TNF-?and NLR?and nutritional indicators?Alb,PA,Hb and MQSGA?among different groupsSerum levels of hs-CRP were negatively correlated with serum Alb and PA levels in group N?r=-0.368,-0.368,P<0.001?;serum IL-6 levels were negatively correlated with serum Alb and PA levels?r=-0.440,-0.256,P<0.001?;serum TNF-?levels were negatively correlated with serum Alb and PA levels?r=-0.638,-0.572,P<0.001?;serum NLR levels were negatively correlated with serum Alb and PA levels?r=-0.264,-0.256,P<0.001?;the MQSGA score was positively correlated with serum hs-CRP,IL-6,TNF-?and NLR?r=0.453,0.430,0.242,0.350,P<0.001?.Serum Alb levels and serum hs-CRP,IL-6,TNF-?,NLR was negatively correlated in group I?r=-0.811,-0.756,-0.524,-0.787,P<0.001?;serum PA levels were negatively correlated with serum hs-CRP,IL-6,TNF-?and NLR levels?r=-0.878,-0.536,-0.647,-0.825,P<0.001?;the MQSGA score was positively correlated with serum hs-CRP,IL-6,TNF-?and NLR?r=0.713,0.618,0.628,0.526,P<0.001?.Serum levels of hs-CRP were negatively correlated with serum Alb and PA levels in group L?r=-0.516,-0.500,P<0.001?;serum IL-6 levels were negatively correlated with serum Alb and PA levels?r=-0.841,-0.763,P<0.001?;serum TNF-?levels were negatively correlated with serum Alb and PA levels?r=-0.846,-0.749,P<0.001?;serum NLR levels were negatively correlated with serum Alb and PA levels?r=-0.500,-0.674,P<0.001?;the MQSGA score was positively correlated with serum hs-CRP,IL-6,TNF-?and NLR?r=0.578,0.498,0.713,0.612,P<0.001?.Conclusion:1.VitD deficiency is common in CAPD patients,and inflammation is more common in patients with CAPD.2.VitD deficiency is inseparable from the inflammatory state and malnutrition of CAPD patients.It is an appropriate supplementation of active VitD to increase the 25?OH?D level in the body,actively improve the inflammatory state and correct nutritional status,and effectively prevent and treat various complications of CAPD patients.,so that patients benefit in many ways.