Effect Of Hemodiafiltration On IL-37,IL-6,FGF23,and Klotho Proteins In Maintenance Hemodialysis Patients

Objective Microinflammation and calcium and phosphorus metabolism disorders have become important issues that cannot be ignored in patients with CKD.This subject aims to investigate the effects of Hemodiafiltration(HDF)on serum interleukin-37(Interleukin-37,IL-37),IL-6,Fibroblast growth factor 23(FGF23),Klotho Protein,intact Parathyroid hormone(i PTH),high-sensitivity C-reactive protein(hs-CRP),?2-microglobulin(?2-microglobulin,?2-MG),calcium,Ca),phosphorus(Porus,P),to provide experience for the control of micro-inflammatory response and abnormal mineral metabolism in patients with CKD.Method Accordance to the inclusion and exclusion criteria,twenty-five maintenance hemodialysis patients at Qingdao Central Hospital from May 2018 to December 2018 were selected.Infections,tumors,and immune system in the last 3 months were excluded.Illness,severe liver disease and heart failure.Using the German Fresenius 4008 S diafiltration machine,the dialysis machine(Hi18)produced by Braun(BRAUN),the urea clearance rate is 198ml/min,the ultrafiltration coefficient is 99ml/mm Hg·h,The effective membrane area is 1.8m2.The post-dilution method is used for hemodiafiltration.The total amount of replacement fluid is 17-25 L and the dialysate flow rate is 500ml/min,blood flow 200ml/min.Using autologous arteriovenous fistula as the vascular access,ordinary heparin or low-molecular-weight heparin for anticoagulation,and perform hemodiafiltration treatment once a week and high-throughput hemodialysis twice a week.Five milliliter blood samples were collected from the venous end of the arteriovenous fistula before hemodiafiltration treatment.The ultrafiltration was stopped 5 minutes before the end of dialysis,and 5 milliliter blood samples were extracted from the arterial end,and serum IL-37,IL-6,FGF23,Klotho Protein,CRP,?2 microglobulin,i PTH,Ca,P levels were measured.Twenty volunteers who underwent health examinations at the examination center of our hospital during the same period were selected,as healthy control groups,measured the levels of the above indicators.Patients in the dialysis group received regular hemodialysis treatment for 3 months.Blood samples were collected from the venous end of the internal fistula before HDF treatment,and serum IL-37,IL-6,FGF23,Klotho protein,CRP,?2 microglobulin,Ca,P and i PTH levels were measured.Results The levels of IL-37,IL-6,FGF23,hs-CRP,?2-MG,i PTH,and phosphorus in the serum of MHD patients were higher than that of the healthy control group,and the level of Klotho protein was lower than that of the healthy control group.The difference was statistically significant(P <0.05),the serum calcium level of MHD patients was not significantly different from the healthy control group;after a single HDF treatment,the serum IL-37 level,?2-MG,FGF23 level,i PTH and phosphorus levels in MHD patients were lower than before,The blood calcium level and Klotho protein level were higher than before,the difference was statistically significant(P <0.05);hs-CRP,IL-6 levels had no significant difference before and after HDF(P> 0.05).After 3 months of regular HDF treatment,the levels of IL-37,FGF23,?2-MG,and i PTH in the serum of MHD patients were lower than before HDF(P <0.05),and the level of Klotho protein was higher than before dialysis(P <0.05),IL-6.The levels of calcium and hs-CRP were not significantly different from those three months ago(P> 0.05).Conclusion The levels of IL-37,IL-6,FGF23,hs-CRP,?2-MG,i PTH and P in the serum of MHD patients are significantly higher than that of healthy people,and the level of Klotho protein is lower than that of healthy people.MHD patients generally have micro-inflammatory state and calcium and phosphorus metabolism disorders.HDF can effectively remove IL-37,FGF23,?2-MG,i PTH,P and other factors in patients with CKD,and has a positive significance for treating the microinflammatory state and calcium and phosphorus metabolism disorders in patients with uremia.Serum phosphorus in patients with MHD has a positive correlation with i PTH,IL-37 has a positive correlation with hs-CRP,IL-6 has a positive correlation with FGF23,and no other indicators have found a significant correlation.