The Relationship Between Micro Inflammatory State And Volume Overload In Maintenance Peritoneal Dialysis

Objective: The purpose of this study was to discuss the relationship between micro inflammatory status and volume overload in maintenance peritoneal dialysis(MPD).Methods: A cross-sectional study was designed.Patients with continuous ambulatory peritoneal dialysis(CAPD)in our peritoneal dialysis center from October 31,2018 to October 31,2019 were enrolled.Volume status were assessed by body composition monitoring(BCM),including total body water(TBW),extracellular water(ECW),and overhydration(OH).All patients were divided into the normal volume group and the volume overload group by using OH > 1.1lL as the boundary value.Patients with or without cardiovascular disease(CVD)were divided into CVD group or non-CVD group.To collect demographic data,including serological indicators,clinical edema states,while detecting inflammation factors including high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10),tumor necrosis factor(TNF),vascular cell adhesion factor-1(VCAM-1),albumin(ALB),etc.?The relationship between inflammation factors and volume load was analyzed by T test,Pearson or Spearman correlation analysis and multiple regression analysis.Results: 1.A total of 103 patients were enrolled,including 42(40.78%)males,the average age was 52.97±14.56 years and the median dialysis age was 46(27,73)months.The primary disease mainly included 62(60.1%)cases of chronic glomerulonephritis,17(16.5%)cases of diabetic nephropathy,and 10(9.7%)cases of hypertensive kidney damage.There were 22(20.3%)patients with diabetes,91(88.3%)patients with hypertension and 14(13.5%)patients with CVD.82.5% of the patients took two or more than two kinds of medications to control their blood pressure.Volume was assessed by BCM,76(73.7%)patients OH >1.1L,97(94.1%)patients ECW/TBW?0.4,and 49(47.5%)patients with clinical positive edema.2.Clinical data in the two different volume load groups:(1)The proportion of patients with hypertension,the rate of edema,and the utilization rate of antihypertensive drugs in the volume overload group were all higher than those in the normal volume group(p < 0.05);(2)The urine volume and ultrafiltration volume in the volume overload group were less than those in the normal volume group(p < 0.05).3.Inflammation factors in the two different volume load groups.Patients in volume overload group serum IL-6(24.07ng/L vs 19.72ng/L,p < 0.01),IL-8(1379.80ng/L vs 1101.50ng/L,p < 0.01),TNF(627.03ng/L vs 463.51ng/L,p < 0.01),and VCAM-1(569.41ng/L vs 475.23ng/L,p < 0.01)were significantly higher than those in the normal volume group.4.Inflammation factors in two groups with or without CVD: Patients with cd serum hs-CRP(6.06mg/L vs 1.35mg/L,p < 0.01),IL-6(25.56ng/L vs 22.51ng/L,p < 0.01),TNF(657.93ng/L vs 536.02ng/L,p < 0.01),and VCAM-1(639.81ng/L vs 528.78ng/L,p < 0.01)were significantly higher than patients without CVD.5.The relationship between inflammation factors and volume load in CAPD patients: Pearson and Spearman correlation analysis found that:(1)hs-CRP was positively correlated with the degree of edema(p < 0.05).(2)IL-6,IL-8,TNF,VCAM-1 were positively correlated with OH,ECW/TBW and degree of edema(p < 0.05).(3)IL-10 was negatively correlated with OH and ECW/TBW(p < 0.05).6.Multiple regression analysis of the relationship between inflammation and volume:(1)Multiple Logistic regression analysis showed that urine volume(OR=0.996),ultrafiltration volume(OR=0.997),IL-10(OR=0.974,p < 0.05)and TNF(OR=1.029)were independent risk factors of volume overload(p < 0.05).(2)Multiple linear regression correction to eliminate confounding factors,OH was an independent factor affecting the increase of inflammation factors such as IL-6,TNF,VCAM-1,and IL-8(p < 0.01).Conclusions: This study found that: 1.73.7% of PD patients was volume overload,and about 46.1% patients with volume overload without clinical edema.2.Inflammation factors were significantly increased in patients with volume overload and patients with CVD.3.Volume overload and microinflammatory status were independent of each other.