Clinical Study On The Removal Of The Ferritin In Peritoneal Dialysis

Objective: The relative or absolute decrease of erythropoietin(EPO) followed with the deterioration of renal function in patients with chronic kidney disease(CKD) leads to renal anemia(RA).RA is one of common complications for patients with CKD,and the morbidity of it in CKD is 40~60%. Further, iron deficiency is another important reason for RA. Serum ferritin(SF) is a main storage form of iron in human body, SF levels could be regard as an indicator to identify iron deficiency or overload. Nowadays, SF and transferrin saturation(TSAT) are used as indexes to estimate iron status in human. Previous guidelines for RA, such as <diagnosis and treatment of renal anemia of china expert consensus> at 2013 and 2014 indicated that TSAT<20%, SF<100 ug/L in patients with non-dialysis and peritoneal dialysis(PD) or SF<200 ug/L at hemodialysis(HD) should be given ferralia therapy, SF>500 ug/L should not be given ferralia by vein, and TSAT≧50% and(or) SF≧800 ug/L should stop to give ferralia by vein for three months. Studies reported that there was 15%~22% absolute absence of iron in patients with HD, but 41%~45% in PD. At the end of 2008, a survey on treatment for anemia in patients with dialysis in shanghai discovered that the rate reaching the standards for anemia treatment was 60.72% and 32.17% in PD and HD groups, respectively. There was still quite a few people have not reached the target value, especially more than half of the patients with PD. It is difficult for PD patients to meet the treatment goal because of iron will be loss followed by the loss of blood in dialysis channels, iron deficiency will be more serious. Inversely, it was not this case depends on the above studied results. So far, the target values of iron therapy for non-dialysis and PD are the same. Compared to non-dialysis, toxins could be removed by PD, but nutrients are also cleared away. the rate of absolute deficiency of iron is high, and the rate to reach the treatment goals is so poor in patients with PD. There is a few of research to answer whether this is associated with a loss of iron and ferritin in peritoneal dialysis. In addition, there are many hazards for high levels of SF in patients with PD. Studies at abroad showed that high levels of SF was one of the risk factors to the occurrence of an acute myocardial infarction(AMI) for coronary heart disease(CHD) patients. It is worth noting that cardiovascular events are the first death risk factors for dialysis patients. Newly studies reported that residual renal function(RRF) of patients with PD was negatively associated with SF, and ferritin could aggravate the defuctionalization of RRF. To sum up, the concentrations of SF in patients with PD is closely associated with anemia, RRF, quality of life and prognosis, and this experiment was aimed to observe the associated factors with ferritin levels in PD patients, and the removal for SF of PD.Methods: We recruited 25 patients with peritoneal dialysis from October 2014 to May 2013 in the first hospital of Qin Huang Dao. Gender, age, height, weight, body mass index(BMI), peritoneal dialysis age, Peritoneal transport type, KT/V, primary disease, the presence of infection were collected.Hemoglobin(Hb), albumin(Alb), SF, serum iron(Fe), transferring(TRF), creatinine(Cr), blood urea nitrogen(BUN) and parathyroid hormone(PTH) were detected at per-dialysis and post-dialysis. To calculate the removal rate(RR) of SF, Fe, TRF, Cr, BUN and PTH). Record the volume of collected dialysate, and detect the concentration of SF, Fe, TRF, Cr, BUN and PTH.The total removal of peritoneal solute removal(TR) was used as a gold standard.All analyses were performed using the SPSS 13.0 statistical software(SPSS Company, Chicago, Illinois, USA). One pearson correlation was used for The concentration of per-dialysis SF and the sex, age, dialysis times,, height, weight, BMI, KT/V, Hb, Alb. According to the results Multiple linear regression models(stepwise method) were used to evaluate the relationships between The concentration of per-dialysis SF and relevant indicators. To analysis the concentration changes per and post dialysis. To measure the strength of the association between two variables, One pearson correlation was used for The concentration of per-dialysis SF and SF in colocted dialysate, another pearson correlation was used for The concentration of per-dialysis SF and the TR of SF. and a Spearman correlation coefficient were used for the RR of Fe, TRF, Cr, BUN and PTH.Results:1 BMI, peritoneal function and RRF infection, and Hb were used as independent variables, and the per-dialysis SF as the dependent variable, the stepwise multiple linear regression analysis showed that the levels of per-dialysis SF was associated with infection, RRF(R=0.982, R2=0.964, P<0.05).Infection, RRF were regards as X1, X2, respectively. the regression equation was Y^=815.649+740.028X1-476.18X2, F=238.169, P<0.001(P<0.05).2 Pre and post dialysis, The concentrations of BUN, Cr, PTH were significantly different(P<0.05), but, the concentrations of serum SF, Fe were not statistically significant.(P>0.05).3 The concentration of per-dialysis SF was positivily associated with the the concentration of serum ferritin in collocted dialysate(SF)(r=0.636 P=0.026).4 The concentration of per-dialysis SF was positivly associated with the total remove of serum ferritin(SF)(r=0.618,P<0.05).5 Spearman correlation analysis revealed that the decline rate of SF was not associated with Cr, BUN, Fe, TRF, PTH(P=0.070、P=0.218、P=0.265、P=0.336).Conclusions:1 SF is positively correlated with infection, is negatively correlated with RRF.2 SF and Fe can be detected in collected dialysate. SF concentrations are positivly associated with the total removal and concentrations of SF in colocted dialysate, there is concentration-dependent.3 the removal is different among small moleculars, medium molecules and large moleculars in peritoneal, Further researches for the mechanism are needed.