Effect Of Different Hemodialysis Modes On Serum Amyloid A Levels In Patients With End-stage Renal Disease And Its Significance

Objective:To compare the effects of different hemodialysis modes on serum amyloid A(serum amyloid A,SAA)levels in patients with end-stage renal disease(ESRD).A preliminary discussion of the correlation between SAA and quality of life of patients and dialysis related complications.Methods:selected ESRD patients who were hospitalized in the nephrology department of the affiliated hospital of the north chuan medical college from january to october 2019,but the patients who did not undergo hemodialysis treatment,the regular hemodialysis patients in the hemodialysis center and the healthy population of the same time physical examination were 118.grouping method:1.Control group:40 healthy people with physical examination during the same period.2.ESRD group:29 patients with ESRD without hemodialysis.3.group of 27 patients with ESRD who underwent regular hemodialysis(3cycles/week,4h/each)for more than 3 months.4.Blood dialysate(hemodiafiltration,HDF)group:22 patients with ESRD who performed regular hemodialysis filtration(on a routine HD basis,1 HDF every 2 weeks,4h/each)over 3 months were treated.the general clinical data,such as sex,age,body mass index(Body mass index,BMI),systolic blood pressure(systolic blood pressure,SBP),diastolic blood pressure(diastolic blood pressure,DBP),were collected.Meanwhile,renal function related indexes were detected:urea nitrogen(blood urea nitro gen,BUN),serum creatinine(serum creatinine,Scr);metabolic related indexes:plasma glucose(Glu),triglycerides(Triglycerides,TG),total cholesterol(Total Cholesterol,TC),high density lipoprotein(High density lipoproteins,HDL),apolipoprotein A1(apoAl),apolipoprotein B100(apoB1),lipoprotein a(LPa);Related indicators of inflammation:C reactive protein(C reactive protein,CRP);nutritional related indicators:hemoglobin(Hemoglobin,Hb),serum albumin(albumin,Alb);calcium and phosphorus metabolism indicators:calcium(Calcium,Ca),phosphorus(Phosphorus,P),parathyroid hormone(Parathyroid hormone,PTH);Cardiac function related indicators:Left ventricular end-diastolic diameter(Left ventricular end-diastolic diameter,LVDd),left atrial appendage(Left atrium diameter,LAD),inter ventricular septal thickness(inter ventricular septal thick ness,IVST),left ventricular posterior wall thickness(Left ventricular posterior wall thickness,LVPWT),ejection fraction(ejection fraction,EF),left ventricular mass(left ventricular mass,LVM)?left ventricular mass Index(left ventricular mass Index,LVMI)etc.chi-square test,independent sample t test,rank sum test were used to compare the clinical indicators difference between groups.chi-square test,variance F test and rank sum test were used to compare the differences between clinical indexes and SAA levels between groups.LSD-t method was used for pairwise comparison between groups.using Spearman correlation analysis of the relationship between SAA and clinical indicators.multivariate correlation analysis using multivariate linear regression models.Result:1.the SAA levels were compared between the four groups:the average water of SAA in ESRD group,HD group and HDF group were higher than those in the control group,and the SAA level in HD group was the highest,and the difference was statistically significant(p<0.05).The difference of SAA level between HD group and HDF group was statistically significant(P<0.05),while the difference of SAA level between ESRD group and HDF group was not statistically significant(P>0.05).2.The difference of SAA level between the four groups:the SAA level of patients with left ventricular hypertrophy was higher than that without left ventricular hypertrophy,and the difference was statistically significant(P<0.05).3.Spearman correlation analysis between SAA and the clinical indicators:SAA levels were significantly positively correlated with Glu?Lpa?P?PTH?BUN?Scr?CRP?LVM?LVMI(r>0),whereas SAA levels were Significant negative correlation with TC?HDL?apoA1?apoB1?Ca?Hb?Alb?EF(r<0).4.multivariate linear regression analysis:SAA levels were correlated with Scr and Hb(p<0.05),and Scr was positively correlated with SAA index(B>0).Hb was negatively correlated with SAA index(B<0),and there was no correlation between the remaining indexes and SAA level(p>0.05).to further test the univariate Spearman correlation,multi-element linear regression was performed.the results showed a negative correlation between SAA levels and Hb levels in patients with ESRD(B<0,P<0.05).The larger the SAA,the smaller the Hb.Conclusion:1.Different hemodialysis methods have different effects on inflammation,nutrition,energy metabolism,calcium and phosphorus metabolism in ESRD patients.2.The clearance of SAA by HDF is better than that of HD,which can reduce the microinflammatory state of dialysis patients,correct malnutrition and reduce the occurrence of cardiovascular complications.3.SAA levels may be a risk factor for left ventricular hypertrophy and anemia in ESRD patients.4.SAA can be used as a meaningful index to predict the related complications such as microinflammation,malnutrition,metabolic disorder,cardiovascular disease and so on in ESRD patients.