Shutov Evgeny, Mishin Oleg
Nephrological Center of the Hospital Named after S.P. Botkin, Moscow, Russian Federation.
Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation.
Blood Purif. 2023;52 Suppl 1(Suppl 1):43-48. doi: 10.1159/000529716. Epub 2023 Mar 29.
The inflammation syndrome is typical for chronic kidney disease (CKD) and increases with the progression of CKD. It is extremely important to monitor the markers of inflammation in patients with CKD, as there is a clear relationship between the level of inflammation and mortality in these patients. Currently, there is no single approach to the treatment of chronic inflammation in patients with CKD.
This was a prospective open cohort study. We studied 31 patients on hemodialysis from March 1, 2020, to August 1, 2021, in 2 Moscow clinics (No. 7 and S.P. Botkin). Inclusion criteria for patients in the study were an adequate dialysis according to the KT/V index ≥1.4, absence of an active inflammatory process or infections, age over 18 years, standard hemodialysis regimen of 3 times per week, at least 4 h, levels of interleukin-6 (IL-6), IL-8, and C-reactive protein (CRP) above the reference values. Patients were transferred from hemodialysis performed using a standard polysulfone (PS) membrane to a polymethylmethacrylate (PMMA) membrane (Filtryzer BK-2.1F). For dialysis treatment in patients, blood flow rates of 250-350 mL/min were used, and the flow rate of the dialysis solution was set at 500 mL/min. The control group consisted of 19 patients, with similar inclusion parameters, who continued their treatment with hemodialysis using a PS membrane. The aim of the research was to study the effect of the dialysis membrane (Filtryzer BK-2.1F) on the level of inflammation in routine practice compared to a PS membrane. Adverse events were monitored.
By the end of the study, after 12 months, the levels of cytokines significantly decreased only in patients who had treatment with PMMA membrane, starting from the 3rd month of treatment, and became close to normal levels: IL-6 from 16.9 ± 8.0 to 8.5 ± 4.8 pg/mL (p ≤ 0.0001); IL-8 from 78.5 ± 11.4 to 43.6 ± 11.6 pg/mL (p ≤ 0.0001); and CRP from 10.33 ± 2.83 to 6.15 ± 1.57 mg/L (p ≤ 0.0001). Values of inflammation markers did not change in control group.
In our study, we demonstrated for the first time a significant reduction in the level of inflammation in patients on standard hemodialysis in routine practice due to the use of PMMA membranes.
炎症综合征是慢性肾脏病（CKD）的典型表现，并随着CKD的进展而加重。监测CKD患者的炎症标志物极为重要，因为这些患者的炎症水平与死亡率之间存在明确关联。目前，对于CKD患者慢性炎症的治疗尚无单一方法。
这是一项前瞻性开放队列研究。我们于2020年3月1日至2021年8月1日在莫斯科的两家诊所（第7诊所和S.P.博特金诊所）对31例接受血液透析的患者进行了研究。研究中患者的纳入标准为根据KT/V指数进行充分透析（≥1.4）、无活动性炎症过程或感染、年龄超过18岁、每周进行3次标准血液透析治疗（每次至少4小时）、白细胞介素-6（IL-6）、IL-8和C反应蛋白（CRP）水平高于参考值。患者从使用标准聚砜（PS）膜进行的血液透析转换为使用聚甲基丙烯酸甲酯（PMMA）膜（Filtryzer BK - 2.1F）进行血液透析。对患者进行透析治疗时，血液流速为250 - 350 mL/分钟，透析液流速设定为500 mL/分钟。对照组由19例具有相似纳入参数的患者组成，他们继续使用PS膜进行血液透析治疗。本研究的目的是在常规实践中，比较透析膜（Filtryzer BK - 2.1F）与PS膜对炎症水平的影响。对不良事件进行了监测。
在研究结束时，即12个月后，仅在使用PMMA膜治疗的患者中，从治疗第3个月开始，细胞因子水平显著下降，并接近正常水平：IL-6从16.9±8.0降至8.5±4.8 pg/mL（p≤0.0001）；IL-8从78.5±11.4降至43.6±11.6 pg/mL（p≤0.0001）；CRP从10.33±2.83降至6.15±1.57 mg/L（p≤0.0001）。对照组炎症标志物的值未发生变化。
在我们的研究中，我们首次证明在常规实践中，使用PMMA膜可使接受标准血液透析的患者炎症水平显著降低。
