The Study In Hemoperfusion Combined With Hemodialysis In The Treatment Of Chronic Renal Failure

Chronic kidney diseases(CKD) mostly accompanied with various chronic diseases refers to the chronic kidney structure and function disturbance caused by all kinds of reasons. This kind of disease has common characteristics like kidney function disturbance and ingravescence. With the development of illness, end-stage renal disease will be finally caused. Inflammatory reaction is one of the main inducement factors of chronic kidney disease development. For all kinds of reasons like gene, immune response, oxidative stress,mitochondria damage, etc, chronic kidney diseases will cause release of inflammatory factors which enter blood circulation. At the same time, kidney function disturbance will cause the body accumulation of toxin, including the reduce of inflammatory factor clearance rate. Human body inflammatory affection like kidney interstitial fibrosis will accelerate the kidney failure. When chronic kidney diseases occur, body lesions and decline of related kidney filtration ability will cause the dramatic clearance rate decline and body accumulation of toxin, homocysteine, etc. However, the accumulation of these substances is closely linked with kidney function decline and cardiovascular complication.In particular, cardiovascular system complication has become one of the independent factors of cardiovascular diseases evaluation.At present, main method of clinic treatment for kidney failure patients is dialysis treatment. Hematodialysis treatment has so many researches of cleaning the inflammatory factors in patients’ blood but no final conclusion of clearance rate of homocysteine until now. Researches have showed that clinical hemodialysis patients are mostly accompanied by hyperhomocysteinemia, the body accumulation of which will cause cardiovascular complication, seriously affect patients’ life health and increase treatment risks. Bloodperfusion is to realize purification in way of extracorporeal circulation. With help of solid state devices, the blood is filtered to absorb and reduce the exogenous and endogenous substances in blood. Currently this method is mostly used for drug poisoning salvage and poison intoxication salvage. Until now there is no final conclusion for the hemoperfusion’s clearance rate and clinical researches of endogenous substances like inflammatory factors,homocysteine, etc in kidney failure patients’ blood. This project aims to inspect blood perfusion’s effects on endogenous substance level like serum homocysteine of kidney failure rat through rat extracorporeal perfusion experiment. In addition, this project discusses the effects of blood perfusion combined dialysis treatment on the recovery of kidney failure patients’ serum physiological level through clinical observation of the clearance effect differences of single dialysis treatment and blood perfusion combined dialysis treatment on patients’ endogenous substances like serum inflammatory factors,homocysteine, etc.Method: ① Building kidney failure model induced by adenine; setting A normal control group; B model group; C blood perfusion group; using the detection of rat serum Scr and BUN level to prove the successful building of model; ② Adopting resinous HA130 padding to prepare extracorporeal blood perfusion column, using model rat blood for blood perfusion, detecting indexes like inflammatory factors, homocysteine, etc in model rat blood after perfusion; ③conduct clinical observation of patients after mere hematodialysis and combined treatment of blood perfusion combined with hematodialysis,detecting and comparing respectively the serum inflammatory indexes and Hcy, PTH andβ2-MG level of patients in both teams.Results: ①Compared with normal group, there are significant differences of Scr and BUN level in rat serum in the process of kidney failure model making, which has proved the success of molding; as for adopted extracorporeal blood perfusion column,homocysteine(Hcy), parathyroid hormone(PTH), β2-microglobulin(β2-MG), IL-1β, IL-6, TNF –α, IL-10, and CRP in serum are quite different with each other when comparedwith normal group, model group, and blood perfusion group. ②Semiquantitative PCR has detected that the m RNA expression level of animal PTH in model group is obviously higher than that in normal group. ③Semiquantitative Western blot has detected that the PTH protein expression level of kidney in model group is obviously higher than that in normal group. ④ Before treatment, there is no significant difference of serum IL-1β, IL-6,IL-8, and IL-10 level of patients in single dialysis treatment group and combined treatment group with P>0.05. However, 4 weeks, 8 weeks and 12 weeks after treatment, the serum IL-1β, IL-6, IL-8, and IL-10 level in combined treatment group is lower than the simultaneous detection level in single dialysis treatment group with P < 0.05; before treatment, there is no significant difference of serum CRP, TNF-α and PCT level in both groups with P>0.05. While 4 weeks, 8 weeks and 12 weeks after treatment, serum CRP,TNF-α and PCT level in combined treatment group are all lower than that in dialysis treatment group with P<0.05; before treatment, there is no significant difference of serum Hcy, PTH and β2-MG level in both groups with P>0.05. However, 4 weeks, 8 weeks and12 weeks after treatment, the serum Hcy, PTH and β2-MG level in observation group is lower than the simultaneous detection level in matched group with P<0.05.Conclusion: blood perfusion combined with dialysis treatment is able to effectively lower the serum inflammatory factors, serum Hcy, PTH and β2-MG level. Compared with single dialysis group, it is also able to effectively lower the homocysteine and prevent it from recovering to the level before dialysis, ensuring the treatment effects.