The influence of various blood purification methods on microinflammatory state in patients with maintenance hemodialysis

Objective To investigate the influence of regular hemodialysis(HD),high-flux hemodialysis(HFD) and hemoperfusion(HP) on microinflammatory state in ESRD patients on maintenance hemodialysis(MHD).Methods We enrolled 48 patients with MHD for more than 6 months in this hospital and divided them randomly into HD group(n=16),HFD group(n=16) and HD+HP group(n=16).Serum CRP,IL-6 and TNF-α were measured by immunoturbidimetry and ELISA in patients before and after the first dialysis session,and after the treatment for 3 months,as well as in 20 healthy volunteers as normal controls.Results(a) Serum CRP,IL-6 and TNF-α were significantly higher in the 3 groups of patients than in normal controls(P0.001),but had no differences among the 3 groups of patients before the treatment(P 0.05).(b) In HD group,serum CRP,IL-6 and TNF-α increased after first dialysis session and after the treatment for 3 months,but the increases were statistically insignificantly(P0.05).(c) In HFD group serum CRP,IL-6 and TNF-α decreased after the first dialysis session,but the decreases were statistically insignificant(P 0.05).After the treatment for 3 months,however,serum IL-6 and TNF-α levels decreased significantly(P0.05) without change of serum CRP level(P0.05).(d) In HD+HP group,serum IL-6 and TNF-α decreased after the first dialysis session(P0.05) without change of serum CRP(P 0.05).After the treatment for 3 months,serum CRP,IL-6 and TNF-α decreased(P0.01),but were still higher than those of normal control group.(e) After the treatment for 3 months,serum CRP,IL-6 and TNF-α were significantly lower in HD+HP group than in HFD group,and the extent of the decreases was larger in HD+HP group than in HFD group.Conclusions(a) Microinflammation state exists in ESRD patients on MHD.(b) The lowering of patients' serum CRP,IL-6 and TNF-α and thus the recovery from microinflammatory state can be achieved by HFD and HP,and preferably by HP.(c) Patients' microinflammatory state can not radically corrected after 3 months treatment,therefore,other measures and longer period of follow-up must be conducted for these patients.