Impact of High-Flux Hemodialysis on Chronic Inflammation, Antioxidant Capacity, Body Temperature, and Immune Function in Patients with Chronic Renal Failure.

In order to probe into the impact of high-flux dialysis and hemodiafiltration on patients with chronic rental failure, this paper selects in total 92 cases with chronic renal failure receiving hemodialysis from November 2018 to July 2021, allocating them into two groups based on the random table, each with 46 cases. The control group received hemodiafiltration, the observation group is given high-flux hemodialysis, and we compared serum inflammatory factor level and antioxidant factor level before and after treatment, as well as cellular immune factor level (CD3+, CD4+) and humoral immune factor level (IgE) before and after treatment in the two groups; the renal function, serum total calcium ion level, and serum phosphorus ion level in the two groups were compared before and after treatment, as well as the proportion of metabolic abnormalities in calcium and phosphorus ion levels during treatment; the trend of changes in axillary temperature during treatment in the two groups is analyzed. After treatment, serum inflammatory factor level (hs-CRP & TNF-α) is lower than that in the control group (P < 0.05), antioxidant factor level (MDA) is lower than that in the control group (P < 0.05), and SOD level is higher than that in the control group (P < 05). After treatment CD3+ and CD4+ levels in the observation group are higher than those in the control group (P < 0.05). For patients with chronic renal failure, high-flux hemodialysis is available to better reduce inflammatory response, improve antioxidant and immune capacity in the body, and help maintain calcium and phosphorus metabolic balance.

1. Introduction

Chronic kidney-related diseases will inevitably result in rental failure with the end of the course of disease research [1]. Under the current medical conditions, the most effective way to improve life quality for patients with chronic renal failure is kidney transplantation, but which is difficult to find and expensive, and most patients are still receiving long-term hemodiafiltration [2]. Studies have said that for those with chronic renal failure receiving long-term hemodiafiltration, combined with exogenous microorganisms and even endotoxin, immune complexes accumulated in the body by chronic kidney disease will activate the mononuclear macrophage system as well as other immune systems, resulting in the body a long-term obvious state of chronic inflammatory response and reduced antioxidant capacity [3, 4]. Long-term hemodiafiltration will also have a certain impact on the patient immune function, calcium, and phosphorus metabolism in the body [5].

In recent years, as people increasingly apply PS membrane for high-flux dialysis machine, they can better coordinate the balance between hydrophilicity and hydrophobicity, effectively improving the compatibleness between molecular biofilms and blood. In comparison with the conventional hemodiafiltration in the past, it has a greater ultrafiltration coefficient, while having a stronger adsorption capacity, which can better remove the endotoxins, inflammatory metabolites, and immuno-complexes in patients [6]. Although high-flux hemodialysis has been applied and popularized in patients with chronic renal failure, the research on inflammation, oxidative stress, and immunity of patients after high-flux hemodialysis needs to be further studied, and no study has been seen on the impact of high-flux dialysis on changes in body temperature [7]. Therefore, our work mainly explores the clinical effect of high-flux hemodialysis on patients with chronic renal failure and its impact on inflammation, oxidative stress, immune function, and body temperature.

2. Information and Methods

2.1. General Information

Our team selected 92 patients receiving hemodialysis for chronic renal failure from November 2018 to July 2021 as our research subjects; they signed a consent form before joining the experiment, and we declared for the Ethics board approval.

Inclusion criteria include diagnosed of chronic renal failure clear and renal failure over 1 year; need to receive regular hemodialysis; 40–60 years old [8-11].

Exclusion criteria include those who combined with blood system-borne diseases, malignant tumors, bloodstream infections, chronic cardiopulmonary dysfunction, hepatic insufficiency, receiving immunosuppressants 1 month before joining the group, allogeneic blood transfusion within 3 months before joining, mental illness, during fever phase for body infection, pregnancy, and lactation [12-14].

In accordance with random table, we allocated them into two groups, 46 cases each. Observation group includes 22 male, 24 female, 40–60 years old, average (50.2 ± 1.5), and history of chronic renal failure lasting for 1–3 years, average (2.3 ± 0.2) [15-17].

Causes are as follows: 10 cases with nephrotic syndrome, 10 cases with obstructive kidney failure, 5 cases with immunoglobulin A (IgA) nephropathy, 16 cases with diabetic nephropathy, and 5 cases with interstitial nephritis.

Control group includes the following: 23 male, 23 female, 40–60 years old, average (50.3 ± 1.6), and history of chronic renal failure lasting for 1–3 years, average (2.4 ± 0.2).

Causes include the following: 10 cases with renal syndrome, 10 cases with obstructive kidney failure, 4 cases with IgA nephropathy, 16 cases with diabetic nephropathy, and 6 cases with interstitial nephritis. There is no statistically significant difference between the two groups in comparing sex, age, chronic renal failure history, and causes (P > 0.05).

2.2. Method

All participants received low molecular weight heparin sodium anticoagulant, with dehydration volume of 3000 to 6000 ml/time, and the sodium concentration in dialysis solution is 14 mmol/L, with flow rate set at 500 ml/min. The control group received hemodiafiltration, using dialysis machine 4008S and its matched hemodialysis FX80 from Fresenius Medical Care (USA), with the parameters setting as follows: ultrafiltration coefficient of 59 ml/(h mmHg), filter membrane area of 1.8 m2, and blood flow of 200–250 ml/min. The observation group received high-flux hemodialysis, using dialysis machine 4008B and its matched hemodialysis 18UC from AsahiKASEI (Japan), with the parameters setting as follows: ultrafiltration coefficient of 60 ml/(h mmHg), filter membrane area of 1.8 m2, and blood flow of 280–360 ml/min. Our team performed the above treatment for 4 h each time every 2 to 3 days.

2.3. Observational Indicators

Our team compared serum inflammatory factor level and antioxidant factor level before and after treatment, as well as changes in cellular immune factor level (CD3+, CD4+) and humoral immune factor level (IgE) before and after treatment. Later, we compared the changes in renal function, total serum calcium ion level, serum phosphorus ion level before and after treatment, as well as the proportion of metabolic abnormalities in calcium and phosphorus ion levels during treatment, and analyzed the trend of changes in axillary temperature and the remaining clinical manifestations in the two groups after treatment.

2.4. Standard

Our work is based on the changes in serum inflammatory factors as the standard, like hypersensitive C-reactive protein (hs-CRP, ELISA, <100 ng/L) and tumor necrosis factor-α (TNF-α, ELISA, 5 ng/L–100 ng/L). Oxidative stress indicators included malondialdehyde (MDA, 3.52 mmol/L-4.78 mmol/L) and superoxide dismutase (SOD, 0.242 U/L–0.620 U/L). Cellular immune indicators included CD3+T (flow cytometry, reference value for adult: 955–2860/UL) and CD4+T count (flow cytometry, reference value for adult: 450–1440/0 UL). Humoral immune indicators mainly included IgE (flow cytometry, reference value for adult: 277 U/ml–759 U/ml); L) and serum creatinine (reference value for adult: 2.86 mmol/L–7.14 mmol/L); serum electrolyte level determination included serum total calcium ions (reference value for adult: 2.08 mmol/L–2.60 mmol/L) and serum phosphorus ions (reference value for adult: 0.97 mmol/L–1.61 mmol/L). Changes in body temperature during treatment are represented by axillary temperature (reference value for adult: 36.0°C∼37.0°C). Clinical manifestations during treatment mainly included pruritus, renal osteoporosis, nausea and vomiting, abdominal distention and pain, and restless leg syndrome.

2.5. Statistical Processing

Through SPSS 20.0, our team expressed the data as mean ± standard deviation (SD) and compared the mean between the two groups via t-test, and the intergroup rate through χ2 test. P < 0.05 mean difference is significant.

3. Results before and after Treatment

3.1. Comparison of Serum Inflammatory Factor Level and Antioxidant Factor Level before and after Treatment

There is no statistical significance in comparing serum inflammatory factor level (hs-CRP &TNF-α) with antioxidant factor level (MDA & SOD) between the two groups before treatment (P > 0.05). After treatment, serum inflammatory factor (hs-CRP and TNF-α) level in the two groups is lower than that before treatment (P < 0.05), serum inflammatory factor (hs-CRP and TNF-α) level in the observation group is lower than that in the control group (P < 0.05), antioxidant factor (MDA) level in the two groups is lower than that before treatment (P < 0.05), SOD level is higher than that before treatment (P < 0.05), antioxidant factor (MDA) level in the observation group is lower than that in the control group (P < 0.05), and SOD level is higher than that in the control group (P < 0.05), as shown in Table 1. Figure 1 is the comparison of serum inflammatory factor and antioxidant factor levels before and after treatment.

Table 1

Comparison of serum inflammatory factor level and antioxidant factor level before and after treatment ().

		hs-CRP (mg/L)	TNF-α (g/L)	MDA (mol/L)	SOD (U/L)
Observation group	Before treatment	12.5 ± 1.4	135.6 ± 10.2	6.6 ± 0.4	0.4 ± 0.1
	After treatment	6.9 ± 0.5▲★	41.2 ± 4.3▲★	2.6 ± 0.1▲★	1.1 ± 0.2▲★
Control group	Before treatment	12.6 ± 1.5	135.7 ± 10.1	6.7 ± 0.5	0.5 ± 0.1
	After treatment	9.6 ± 1.1▲	60.4 ± 5.1▲	4.2 ± 0.2▲	0.8 ± 0.1▲

▲ Compared with pretreatment, P < 0.05; ★in comparison with the control group, P < 0.05.

Figure 1

Comparison of serum inflammatory factor and antioxidant factor levels before and after treatment.

3.2. Comparison of Cellular Immune Factor Level (CD3+, CD4+) and Humoral Immune Factor Level (IgE) before and after Treatment

The difference between CD3+ and CD4+ levels and IgE level is not significant (P > 0.05); CD3+ and CD4+ levels are higher than those before treatment (P < 0.05); IgE level is lower than that before treatment (P < 0.05). After treatment, CD3+ and CD4+ levels in the observation group are higher than those in the control group (P < 0.05) and IgE level is lower than that in the control group (P < 0.05), as shown in Table 2. Figure 2 presents the comparison of CD3+, CD4+ levels, and humoral immune factor IgE level before and after treatment.

Table 2

Comparison of CD3+, CD4+ levels+, and IgE level before and after treatment .

		CD3+ (%)	CD4+ (%)	IgE (U/ml)
Observation group	Before treatment	24.5 ± 1.5	14.7 ± 1.0	475.9 ± 38.8
	After treatment	51.5 ± 3.5▲★	42.3 ± 2.9▲★	158.7 ± 12.4▲★
Control group	Before treatment	24.6 ± 1.6	14.8 ± 1.1	475.8 ± 38.9
	After treatment	40.4 ± 2.0▲	25.5 ± 1.6▲	323.8 ± 22.6▲

▲ Compared with pretreatment, P < 0.05; ★in comparison with the control group, P < 0.05.

Figure 2

Comparison of CD3+, CD4+ levels, and humoral immune factor IgE level before and after treatment.

3.3. Comparison of Renal Function before and after Treatment

The differences in urea nitrogen and creatinine levels in the two groups before treatment are not significant (P > 0.05); urea nitrogen and creatinine levels in the two groups after treatment are lower than before (P < 0.05); and the levels of urea nitrogen and creatinine levels in the observation group after treatment are lower than those in the control group (P < 00.05), as shown in Table 3. Figure 3 displays the comparison of renal function before and after treatment between the two groups.

Table 3

Comparison of renal function before and after treatment between the two groups ().

		Urea nitrogen (mmol/L)	Creatinine (mmol/L)
Observation group	Before treatment	35.5 ± 3.8	447.9 ± 15.2
	After treatment	5.8 ± 0.7▲★	88.8 ± 6.3▲★
Control group	Before treatment	35.6 ± 3.9	448.0 ± 15.3
	After treatment	12.5 ± 2.7▲	119.8 ± 18.7▲

▲ Compared with pretreatment, P < 0.05; ★in comparison with the control group, P < 0.05.

Figure 3

Comparison of renal function before and after treatment between the two groups.

3.4. Comparison of Serum Total Calcium Ion and Serum Phosphorus Ion Levels between the Two Groups after Treatment

The serum total calcium ion level in serum is higher than that in the control group (P < 0.05), and the serum phosphorus ion level is lower than that in the control group (P < 0.05), as shown in Table 4.

Table 4

Comparison of serum calcium ion level with serum phosphorus ion level before and after treatment (mmol/L, ).

	Serum total calcium ion	Serum phosphorus ion
Observation group	2.21 ± 0.04	1.28 ± 0.04
Control group	1.91 ± 0.03	1.69 ± 0.05
T	111.503	43.428
P	0.000	0.000

Proportion of hypercalcemia, hypocalcemia, hyperphosphatemia, and hypophosphatemia in the observation group during treatment is lower than that in the control group (P < 0.05), as shown in Table 5.

Table 5

Proportion of metabolic abnormalities in calcium and phosphorus ion levels occurring during treatment in both groups (cases, %).

	Hypercalcemia	Hypocalcemia	Hyperphosphatemia	Hypophosphatemia	Total occurrence
Observation group	1	0	1	0	2 (4.3%)
Control group	7	2	6	1	16 (34.8%)
χ 2	—				11.673
P	—				0.001

3.5. Changes in Axillary Temperature during Treatment in the Two Groups

The difference in pretreatment temperature is not significant (P > 0.05). Axillary temperature during treatment and after treatment in 30min in the observation group is normal and higher than that in the control group, as shown in Table 6. Figure 4 illustrates the axillary temperature in the two groups during treatment.

Table 6

Changes in axillary temperature in the two groups during treatment (°C, ).

	Before treatment	During treatment	After treatment in 30 min
Observation group	36.6 ± 0.3	36.8 ± 0.2	36.7 ± 0.2
Control group	36.5 ± 0.2	35.5 ± 0.7	36.1 ± 0.6
T	1.881	12.111	6.434
P	0.063	0.000	0.000

Figure 4

Axillary temperature in the two groups during treatment.

3.6. Comparison of Clinical Manifestations That Still Existed after Treatment between the Two Groups

The proportion of pruritus, renal osteoporosis, nausea and vomiting, abdominal distension, and pain as well as restless leg syndrome in the observation group is signally lower than that in the control group (P < 0.05), as shown in Table 7.

Table 7

Comparison of clinical manifestations that still existed after treatment between the two groups

	Pruritus	Renal osteoporosis	Nausea and vomiting	Abdominal distension and pain	Restless leg syndrome
Observation group	11/46	8/46	5/46	7/46	3/46
Control group	28/46	26/46	29/46	20/46	18/46
χ 2	12.863	15.116	26.872	8.859	12.094
P	0.000	0.000	0.000	0.003	0.001

4. The Clinical Result Analysis

Chronic renal failure, a clinically universal nephrology-related disease, with the progress of renal dysfunction, will result in metabolic abnormalities in hydrolytic electrolytes and alkaloid and increase in immunological complexes, inflammatory factors, endotoxins, and microorganisms. If not timely and effective treated, it even results in death. At present, giving hemodialysis to patients with chronic renal failure is the most effective intervention to prolong the survival time of patients other than kidney transplantation, in which hemodiafiltration and high-flux hemodialysis are the most universally applied methods, both of which have certain clinical efficacy. Among them, hemodiafiltration is mainly to disperse the impact of removing metabolic products in the blood but with limited impact on removing the molecular products in macromolecule nucleus so that it cannot effectively reduce the body's inflammatory response and improve antioxidant capacity. Long-term hemodiafiltration also has certain damage to patient's immune function. Convection and dispersion are the basic function mechanism of high-flux hemodialysis, which is available to remove endotoxins, immune complex and other medium-molecule and large-molecule substances more effectively than conventional hemodiafiltration, thus improving the clinical effect.

For patients receiving hemodialysis for chronic renal failure, the observation group in this work received high-flux hemodialysis, in comparison with hemodiafiltration given to the control group. Our team compared the serum inflammatory factors, antioxidant factors, CD3+ and CD4+, and IgE levels before and after treatment of the two groups; we found that after treatment, inflammatory factors hs-CRP and TNF-α levels in the t observation group are lower than those in the control group, antioxidant factor MDA level in the observation group is lower than that in the control group, SOD level is higher than that in the control group, CD3+ and CD4+ levels are higher than those in the control group, and IgE level is lower than that in the control group. It is suggested that applying high-flux hemodialysis for patients with chronic renal failure can more effectively reduce inflammatory response, improve antioxidant ability, and reduce the damage to immune function in comparison with conventional hemodiafiltration. Additionally, the changes in renal function before and after the treatment in the two groups are compared. After treatment, urea nitrogen and creatinine levels in the observation group are lower than those in the control group. Although both groups had improved renal function after treatment, the impact of high-flux hemodialysis is more pronounced in the observation group. At the same time, our team compared the total serum calcium ion and serum phosphorus ion levels after treatment and the proportion of metabolic abnormalities in calcium and phosphorus ion level during treatment. It is found that the serum total calcium ion level in the observation group is higher than that in the control group, the serum phosphorus ion level is lower than that in the control group, and the total proportion of hypercalcemia, hypocalcemia, hyperphosphatemia, and hypophosphatemia in the observation group during treatment is lower than that in the control group. It is explained that applying high-flux hemodialysis for patients with chronic renal failure, in comparison with conventional hemodiafiltration, has a positive impact on maintaining calcium and phosphorus metabolic balance, improving the total calcium ion level after hemodialysis, as well as reducing serum phosphorus ion level. Moreover, the research also compared the changes in axillary temperature in the two groups during treatment and found that the axillary temperature during treatment and 30 min after treatment in the observation group is normal and higher than that in the control group. It is suggested that applying high-flux hemodialysis for patients with chronic renal failure is of great value for maintaining the body temperature during treatment. Finally, our group compared the clinical manifestations that still existed after the treatment in the two groups; it is found that the proportion of pruritus, renal osteoporosis, nausea and vomiting, abdominal distension, and pain and restless leg syndrome is signally lower than that in the control group after treatment. It is further explained that applying high-flux hemodialysis for patients with chronic renal failure can better improve the clinical symptoms, ensure the clinical effect, and improve life quality for patients after treatment in comparison with conventional hemodialysis.

In the past, the hemodiafiltration used small aperture membrane and low-flux dialysis machine, with a certain filter impact on small molecular substances such as uric acid, urea nitrogen, and creatinine in the blood, but for medium and large molecular substances, such as inflammatory factors, immune complex, its filter effect is limited, and long-term repeated application also has a significant negative impact on immune function and antioxidant capacity. High-flux dialysis is through high-flux dialysis machine, using Helixone nanocontrolled filament dialysis membrane, with higher biocompatibility and molecular mechanical effect. And, its pore membrane diameter is relatively large, combined with the new cover seamless design, significantly improves adsorption effect for layer cracking turbulence substances, and has important value reduce blood leakage rate. Through the diffusion-convection-absorption circulating mode, it effectively filtrates and removes large, middle, and small molecular toxins in the blood at the same time. In contrast to conventional hemodialysis, it promotes the removal range of toxin species in the body to expand, especially for the effective removal of large molecular toxins with weight of 32M and above, thus preventing their accumulation, further reducing kidney load, and improving renal function.

5. Conclusion

Applying high-flux hemodialysis for patients with chronic renal failure, in comparison with conventional hemodiafiltration, can better reduce inflammatory response and improve antioxidant capacity and immunity in the body. It is conducive to maintaining the calcium and phosphorus metabolic balance, with a small impact on the body temperature during treatment, thus have a positive impact on improving clinical symptoms.