The Microinflammation State Of End-stage Renal Disease And Analysis Of Correlative Factors

Objective:To investigate the inflammation state of end-stage renal disease at the initiation of dialysis and after maintenance dialysis at least three months, and analyze its relationships with renal function、nutritional state and anemia, to provide evidence for taken appropriate clinical interventions to prevent the subsequent complication and improve the prognosis in time.Method:1. Hs-CRP, serum albumin(SALB), serum creatinine, blood urea nitrogen together with other demographic and laboratory data of all 294 ESRD in-patients who initiated their first dialysis treatment between January,2005 and December,2009 at Hunan Provincial People’s Hospital were obtained retrospectively by reviewing the case recards. GFR was estimated using the prediction equation developed from the Modification of Diet in Renal Disease (MDRD) study. The equation was as follow:GFR=170×[Pcr]-0.999×[age(year)]-0.176×[female×0.762]×[BUN]-0.170×[ALB]+0.3182. All these 294 patients who initiated their first dialysis treatment were followed up, and 74 cases of those are undertaking hemodialysis in our hospital currently (3 months< duaration of dialysis< 6 years). The levels of hs-CRP、SALB、serum creatinine、blood urea nitrogen、hemoglobin and other relevant indicators in those 74 dialysis patients were also measured.3. The patients were divided into different groups by various condition and then compared the differences among those groups. Then the differences were also compared with the data of the 514 ESRD patients of the 2006 year study in our hospital. Results:1. Analysis relating indicators in 294 patients who initiated their first dialysis treatment(1). The demographic and clinical characteristics of the 294 observed ESRD patients were as follow:①In those 294 patients, the mean (SD)of age was 54.19±15.14, the ratio between male and female was 1.48:1;②The primary glomerular nephropathy occupied 52.7% of the whole population, the hypertension nephropathy 20.7% and diabetic nephropathy 10.2%. From the year 2005 to 2009, the percentage of glomerular nephritis showed a yearly decrease, whereas that of hypertension nephropathy and diabetic nephropathy had demonstrated a trend of yearly increase during the same observing period;③Compared to the data of the 2006 year study, the age of these 294 patients was significantly elder than that of the 514 ESRD patients of the 2006 year study (P<0.05). The percentage of glomerular nephritis showed a yearly decrease, whereas that of hypertension nephropathy and diabetic nephropathy had demonstrated a trend of yearly increase.(2). Analysis relating to renal function in 294 patients who initiated their first dialysis treatment:①The mean (SD) GFR in these 294 patients was 6.84±4.27ml/min/1.73m2;②GFR is positively correlated with Hb (r=0.252,p<0.001) and ALB (r=0.206,p<0.001);③General speaking, there is no linear correlation between GFR and hs-CRP, when GFR< 10.0 ml/min/1.73m2, GFR is correlated with hs-CRP negatively (r=-0.323,p<0.001).(3). Analysis relating to hs-CRP in 294 patients who initiated their first dialysis treatment patients:①The mean (SD) hs-CRP was 5.22±4.77mg/L, patients with the higher hs-CRP accounted for 59.9% of the whole investigated ESRD population;②In subgroups of older、male、patients with lower ALB and Hb, the mean hs-CRP was significantly higher as compared to corresponding groups(P<0.05);③In 294 patients who initiated their first dialysis treatment, hs-CRP was positively correlated with WBC(r=0.383, P<0.001) and low density lipoprotein (r=0.343, p＜0.001), while it was negatively correlated with ALB (r=-0.326, P＜0.001) and Hb(r=-0.260, P<0.001).2. Analysis relating indicators in 74 maintenance dialysis patients during followed-up.(1). The demographic and clinical characteristics of the 74 followed-up maintenance dialysis patients were as follow:①In 74 maintenance dialysis patients, the mean(SD)of age was 57.21±16.53, the ratio between male and female was 1.23:1;②The primary glomerular nephropathy occupied 55.8%of the whole population, the hypertension nephropathy 18.6%and diabetic nephropathy 11.2%.(2). Analysis relating to hs-CRP in 74 maintenance dialysis patients during followed-up:①The mean (SD) hs-CRP was 4.30±3.92mg/L patients with the higher hs-CRP accounted for 56.4% of the whole population;②The levels of hs-CRP is negatively correlated with ALB (r=-0.436,p<0.001) and Hb (r=-0.512,p<0.001).(3). No statistically significant difference was observed in levels of hs-CRP between the patients who initiated their first dialysis treatment and after maintenance dialysis (P>0.05). In 74 followed-up maintenance dialysis patients, the ALB level of the maintenance dialysis patients was lower than that of the patients who initiated their first dialysis treatment (P<0.05), while the levels of Hb in those patients was significantly higher as compared to patients who initiated their first dialysis treatment (P＜0.05).Conclusion:1. The ESRD patients who initiated their first dialysis treatment was relatively old, male patients were more than the female; Glomerular nephritis was still the primary cause of ESRD, yet the proportion of glomerular nephritis had shown a trend of yearly decline from the year 2005 to 2009, whereas that of hypertension nephropathy and diabetic nephropathy had demonstrated a trend of yearly increase during the same observing period.2. Low levels of renal function existed in the ESRD patients at the initiation of dialysis treatment. The decline in renal function seems to be related to the microinflammation state.3. The prevalence of mircoinflammation was high in ESRD patients. Factors such as age,gender,WBC counts and levels of LDL had an obvious influence on the mircoinflammatory state. As the microinflammation state became more severe, the degree of malnutrition and anemia aggravated.4. In 74 followed-up maintenance dialysis patients, treatment of dialysis could not improving the state of microinflammatory completely. Therefore, routine measurement of CRP in these patients plus undertaking dialysis in time and reducing inflammation, may prevent the complication, improve the prognosis and consequently slow down the renal failure process and extend the patients’lifespan.