Erythropoietin And Micro-inflammatory State In Hemodialysis Patients With Renal Anemia Correlation

BackgroundNearly10years ago, on an international scale epidemiological studies of chronic kidney disease became widespread attention.2012Chinese chronic kidney disease epidemiological investigation showed that adults over the age of18populations of CKD prevalence of10.8%, according to statistics developed CKD patients, about2%of patients will enter the stage of ESRD, require treatment by dialysis or a kidney transplant to maintain life, uremic patients in China is expected about100to200million, the uremic consume enormous health resources has become a huge burden on the public health system. Hemodialysis (MaintenaneeHemodialysis, MHD) is effective in patients with end-stage renal replacement therapy. Although in recent years, blood purification technology has made great progress, but still not ideal MHD prognosis, complications and mortality remains high. Renal anemia is the main cause of death in MHD patients and one of the main sicker. The erythropoietin deficiency anemia in CKD patients is caused by the most common factors, since recombinant human erythropoietin (r-HuEPO) used in clinical practice in1986and has been in CKD patients on dialysis become part of the treatment of anemia. rational use of rHuEPO, not only in patients with end-stage uremic anemia is corrected, reducing end-stage left ventricular hypertrophy in patients with uremia and other cardiovascular complications occur, improve brain function and cognitive abilities of patients, improve patient quality of life and activities of the body ability, but also reduce hospitalizations in patients with end-stage uremia and mortality. Reported in the literature, about90%of patients with renal anemia after rHuEPO, hemoglobin (Hb) levels were significantly increased, however, about10%of patients required the use of larger doses of rHuEPO to make hematocrit (Hct) and hemoglobin (Hb) level to achieve the target goal, this condition is known as "EPO hyporesponsiveness" or EPO resistance. Now widely accepted erythropoietin resistance is defined as:adequate iron stores in the body case, intravenous450IU/kg.w, or subcutaneous administration of300IU/kg.w of rHuEPO4～6months, and can not achieve the Hb/Hct target value or target dose can not be maintained in this target. Now clear that EPO can lead to resistance to many factors, such as inflammation, malnutrition, such as dialysis adequacy. Other causes of low reactivity EPO or EPO resistance common causes include iron deficiency, chronic blood loss,hyperparathyroidism,secondary hyperparathyroidism,aluminum toxicity.hemoglobin disease,vitamin deficiency,multiple myeloma,cancer, hemolysis, inadequate dialysis, ACEI/ARB and the use of immunosuppressive agents, hypersplenism; EPO antibody-mediated pure red cell aplasia (PRCA) and so on. The present study shows that in the case of iron deficiency excluded, MHD patients is caused by micro-inflammatory state EPO or EPO resistance low reactivity main reason. In this study, we mainly discuss erythropoietin different inflammatory state in hemodialysis patients with renal anemia treatment.PurposeErythropoietin explore different inflammatory state in hemodialysis (MHD) patients with renal anemia treatment. To reduce complications and mortality in MHD patients, improve patient quality of life and social rates of return to provide new ideas.MethodsThe107cases of hemodialysis patients were divided into high-sensitivity C-reactive protein low group (0-4.9mg/l)36cases, the level of group (5-9.9mg/l)39cases of high-level group (10-15mg/l)32patients were treated with erythropoietin300U/ (kg.w) and conventional hemodialysis treatment, treatment four months, such as Hb increased to110g/Lor HCT reached0.33, reduction1/3to maintain treatment. Three groups in age, weight, ferritin (SF),transferrin saturation (TAST),parathyroid (PTH), urea clearance index (Kt/V) was no statistical difference between the treatment groups were determined after3the patient’s hemoglobin concentration (Hb), hematocrit (HCT), compared three groups after treatment Hb, HCT whether the differences between.ResultsThree groups of patients in the HB, HCT levels significantly higher than before treatment (P<0.01).Low group Hb (119.4±12.5g/1VS72.9±12.4g/lt=68.44P<0.01), HCT(0.36±0.04VS0.22±0.03t=14.13P<0.01);horizontal group Hb (112.4±11.7g/lVS71.0±11.8g/lt=59.48P<0.01),HCT (0.34±0.04VS0.21±0.03t=10.39P<0.01);level group Hb(98.2±12.1g/lVS70.1±11.4g/lt=22.84P<0.01),HCT(0.30±0.04VS0.21±0.02t=7.33P<0.01).However, a high level group of Hb, HCT levels were significantly lower than in the low-level group (P<0.05,P<0.01),the level of group Hb,HCT levels were significantly lower than the low group (P<0.05). And the low level group, the levels in the treatment group were9weeks,14weeks and reached the optimum range, high-level group after16weeks of treatment Hb, HCT has not yet reached the optimal range.Conclusion1erythropoietin can improve different micro-inflammatory state MHD patients with renal anemia;2. Improvement of renal anemia was negatively correlated with inflammation.3. Clinical treatment, monitoring micro levels of inflammatory factors in MHD patients and provide appropriate intervention for the adjustment of erythropoietin dosage and correct anemia effect is important.