To Compare The Therapeutic Effect Of Different Blood Purification Methods On Secondary Hyperparathyroidism In Maintenance Hemodialysis Patients

Objective:The purpose of this study was to compare the effects of two hemodialysis methods on the indexes of calcium,phosphorus and total parathyroid hormone in maintenance hemodialysis patients and their effects on the prevention and treatment of secondary hyperparathyroidism in maintenance hemodialysis patients,and to explore an optimal dialysis method for the treatment of secondary hyperparathyroidism in maintenance dialysis patients.Methods:Patients who regularly received hemodialysis secondary hyperparathyroidism in the hemodialysis Center of Inner Mongolia Forestry General Hospital from January 2019 to December 2020 were included consecutively,and those who met the inclusion criteria were divided into high-throughput hemodialysis group(HFHD group)and high-throughput hemodialysis combined with hemoperfusion group(HP+HFHD group)according to the dialysis method.Both groups received hemodialysis treatment.Blood calcium(Ca),blood phosphorus(P),calcium-phosphorus product,β2-microglobulin(β2-MG),whole parathyroid hormone(iPTH),C-reactive protein(CRP),serum albumin(ALB),hemoglobin(Hb),urea nitrogen(BUN)and serum creatinine(Scr)were collected after 3,6 and 12 months of treatment The indexes and clinical manifestations(skin pruritus and bone pain score)were compared.Results:1.Finally,60 cases were included in the HFHD group and 52 cases in the HFHD+HP group.After treatment,there was no significant difference in baseline level including age,sex,primary disease(chronic glomerulonephritis,diabetic nephropathy,hypertensive nephropathy,polycystic kidney disease,others)and dialysis age between the two groups(P>0.05).2.Before treatment,there were no significant differences in Ca,P,calcium-phosphorus product,iPTH,Scr,BUN,Hb,β2-MG,CRP and ALB levels between HFHD and HFHD+HP groups(P>0.05).After treatment,the levels of P,calcium-phosphorus product,iPTH,Scr,BUN,β2-MG and CRP in HFHD and HFHD+HP groups at 3 months,6 months and 12 months were decreased compared with those before treatment(P<0.05).The levels of Ca,Hb and ALB were higher than those before treatment(P<0.05).3.After treatment,P,iPTH and β2-MG levels in HFHD+HP group were significantly lower than those in HFHD+HP group at 3 months,6 months and 12 months(P<0.05);The Scr level in HFHD+HP group at 6 months and 12 months was significantly lower than that in HFHD+HP group(P<0.05);The CRP level in HFHD+HP group at 12 months was significantly lower than that in HFHD group(P<0.05).The levels of Ca and Hb in HFHD+HP group at 3 months,6 months and 12 months were significantly higher than those in HFHD+HP group(P<0.05);The ALB level in HFHD+HP group was significantly higher than that in HFHD group at 12 months(P<0.05).4.Before treatment,there were no significant differences in Ca,P,Ca,P product and iPTH compliance rates between HFHD group and HFHD+HP group(P>0.05).After treatment,the rate of Ca reaching the standard was statistically significant at 6 months(P<0.05).P The rate of compliance was statistically significant at 6 and 12 months(P<0.05);The compliance rate of calcium and phosphorus product and iPTH were statistically significant at 12 months(P<0.05).5.Before treatment,there was no significant difference in skin itch score and bone pain score between HFHD group and HFHD+HP group(P>0.05).After treatment,skin pruritus and bone pain in HFHD and HFHD+HP groups were relieved at 3 months,6 months and 12 months compared with before treatment(P<0.05).After treatment,the pruritus in HFHD+HP group was significantly relieved at 6 months and 12 months compared with that in HFHD+HP group(P<0.05).Bone pain in HFHD+HP group was significantly relieved at 12 months compared with HFHD group(P<0.05).6.The effect of iPTH in HFHD group and HFHD+HP group was statistically significant(P<0.05).There was no significant difference in total effective rate(P>0.05).Conclusion:1.High-throughput hemodialysis combined with hemoperfusion can effectively reduce the product levels of P,iPTH and calcium and phosphorus,increase Ca levels,and improve the disorder state of calcium and phosphorus metabolism in patients with SHPT.2.High-throughput hemodialysis combined with hemoperfusion can effectively reduce CRP,Scr and BUN levels,and improve renal function and inflammatory response in patients with SHPT.3.High-throughput hemodialysis combined with hemoperfusion can effectively clear β2-MG levels,increase Hb and ALB levels,and improve anemia and nutritional status of SHPT patients.4.High-throughput hemodialysis combined with hemoperfusion can effectively relieve skin pruritus and bone pain in patients with SHPT.5.High-throughput hemodialysis combined with hemoperfusion can improve the standard compliance rate of Ca,P,iPTH and calcium-phosphorus products in SHPT patients to some extent.6.High throughput hemodialysis combined with hemoperfusion can obviously clear iPTH,which has certain curative effect on SHPT patients and effectively improve the quality of life of patients.