Effects of high-flux hemodialysis combined with Shengxuening on renal anemia and oxidative stress in elderly patients with maintenance hemodialysis

doi:10.3877/cma.j.issn.1674-0785.2021.12.018

Abstract

Abstract:

Objective

To investigate the effects of high-flux hemodialysis (HFHD) combined with Shengxuening on renal anemia and oxidative stress in elderly patients with maintenance hemodialysis (MHD).

Methods

A total of 100 elderly patients with MHD and renal anemia who were treated at Fuyang Second People's Hospital from January 2017 to December 2019 were randomly divided into an observation group and a control group, with 50 cases each. They were all treated with HFHD, and human erythropoietin (rHuEPO) was injected subcutaneously. On this basis, the observation group and the control group were orally given Shengxuening and ferrous succinate tablets, respectively, and the course of treatment was 3 months. The anemia status [hemoglobin (Hb), hematocrit (Hct), and serum ferritin (SF)], nutritional level [albumin (Alb), transferrin (TRF), and total serum protein (TP)], micro-inflammatory state [high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)], oxidative stress level [serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and serum malondialdehyde (MDA)], cardiovascular indicators [B-type brain natriuretic peptide (BNP), mean arterial pressure (MAP), and extravascular lung water index (EVLWI)], and liver and kidney function [creatinine (Scr), β2 microglobulin (β2-MG), and alanine aminotransferase (ALT)] were compared between the two groups, and the occurrence of adverse drug reactions was observed.

Results

After treatment, the levels of Hb, Hct, and SF in the two groups were significantly increased compared with those before treatment (P＜0.05), but there was no statistical significance in each index between the two groups (P＞0.05). The levels of ALB, TRF, and TP in the observation group were significantly increased after treatment (P＜0.05), while no significant changes were observed in the control group (P＞0.05); the levels of ALB, TRF, and TP in the observation group were higher than those in the control group (P＜0.05). The levels of hS-CRP, IL-6, and TNF-α in both groups were significantly decreased after treatment (P＜0.05), and the levels of hS-CRP, IL-6, and TNF-α in the observation group were significantly lower than those in the control group (P＜0.05). SOD and GSH-Px levels in both groups were significantly increased after treatment (P＜0.05), while MDA levels were significantly decreased (P＜0.05). SOD and GSH-Px levels in the observation group were significantly higher than those in the control group, while MDA level was significantly lower than that in the control group (P＜0.05). BNP levels in both groups were significantly decreased after treatment (P＜0.05), while MAP and EVLWI showed no significant changes (P＞0.05); BNP level in the observation group was significantly lower than that of the control group (P＜0.05). The levels of Scr and β 2-MG in both groups were significantly decreased after treatment (P＜0.05), while the level of ALT was not significantly changed (P＞0.05); there was no statistical significance in these indexes between the two groups (P＞0.05). The incidence of pulmonary infection (4.35% vs 8.51%) and digestive tract discomfort (6.52% vs 21.28%) in the observation group was significantly lower than that of the control group (P＜0.05).

Conclusion

HFHD combined with Shengxuening in the treatment of renal anemia in elderly patients with MHD can effectively improve the anemia status, nutritional level, micro-inflammatory status, and oxidative stress, which has positive effects in preventing the occurrence of cardiovascular disease. This combination therapy has appreciated clinical effects and safety.

Key words: Maintenance hemodialysis, Renal anemia, Oxidative stress, High-flux hemodialysis, Shengxuening

Tao Ma, Xiuyong Li, Li Wang, Zhengliang Liu, Tiantian Zhang, Ruixue Wang, Lei Zhang, Xinliang Wang. Effects of high-flux hemodialysis combined with Shengxuening on renal anemia and oxidative stress in elderly patients with maintenance hemodialysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(12): 1009-1015.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2021.12.018

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Figures/Tables 7

组别	例数	性别		年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	透析龄（年， $x ¯$ ±s）	CKD分期（例）			原发肾脏疾病（例）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	透析龄（年， $x ¯$ ±s）	3期	4期	5期	慢性肾炎	高血压肾病	糖尿病肾病	其他
观察组	46	25	21	76.89±10.24	21.07±3.18	2.74±0.85	12	18	16	29	6	8	3
对照组	47	20	27	78.46±10.62	20.83±2.96	2.56±0.91	14	20	13	25	7	10	5
统计值		χ²=1.295		t=0.726	t=0.376	t=0.985	χ²=0.559			χ²=1.085
P值		0.255		0.470	0.707	0.237	0.756			0.781

组别	例数	性别		年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	透析龄（年， $x ¯$ ±s）	CKD分期（例）			原发肾脏疾病（例）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	透析龄（年， $x ¯$ ±s）	3期	4期	5期	慢性肾炎	高血压肾病	糖尿病肾病	其他
观察组	46	25	21	76.89±10.24	21.07±3.18	2.74±0.85	12	18	16	29	6	8	3
对照组	47	20	27	78.46±10.62	20.83±2.96	2.56±0.91	14	20	13	25	7	10	5
统计值		χ²=1.295		t=0.726	t=0.376	t=0.985	χ²=0.559			χ²=1.085
P值		0.255		0.470	0.707	0.237	0.756			0.781

组别	例数	Hb（g/L）		Hct（%）		SF（μg/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	46	74.26±12.09	95.38±10.45^a	28.61±3.04	30.42±2.39^a	136.47±25.83	264.58±37.14^a
对照组	47	73.85±10.72	92.67±12.94^a	28.19±2.87	30.75±2.16^a	134.92±26.05	261.89±32.45^a
t值		0.173	1.109	0.685	1.419	0.288	0.372
P值		0.863	0.270	0.494	0.159	0.774	0.711

组别	例数	ALB（g/L）		TRF（g/L）		TP（g/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	46	26.31±4.85	29.76±4.13^a	1.24±0.37	1.49±0.36^a	52.13±6.47	56.82±7.61^a
对照组	47	26.94±5.03	27.40±4.68	1.28±0.35	1.32±0.41	50.98±6.25	53.29±7.48
t值		0.615	2.576	0.536	2.123	0.872	2.256
P值		0.540	0.012	0.594	0.037	0.386	0.027

组别	例数	hs-CRP（mg/L）		IL-6（ng/L）		TNF-α（μg/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	46	12.98±3.17	9.34±2.19^a	142.76±28.35	106.24±17.68^a	1.29±0.35	0.93±0.21^a
对照组	47	13.25±3.46	10.39±2.63^a	139.84±27.91	118.52±19.43^a	1.26±0.31	1.07±0.24^a
t值		0.392	2.090	0.501	3.186	0.438	2.991
P值		0.696	0.039	0.618	0.002	0.663	0.004

组别	例数	SOD（ku/L）		MDA（mmol/L）		GSH-Px（U/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	46	71.45±10.89	89.72±13.56^a	6.34±1.39	5.13±1.26^a	59.61±8.79	68.92±7.58^a
对照组	47	70.63±12.37	82.16±14.28	6.07±1.42	5.68±1.35	60.47±9.24	64.13±8.35^a
t值		0.339	2.618	0.583	2.030	0.459	2.895
P值		0.735	0.010	0.561	0.045	0.647	0.005

组别	例数	BNP（ng/L）		MAP（mmHg）		EVLWI（ml/kg）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	46	397.82±94.06	246.58±61.39^*	78.23±9.14	79.41±9.34	12.05±2.73	12.96±2.47
对照组	47	394.15±92.73	290.62±72.45^*	76.82±9.36	80.25±9.78	11.64±2.89	13.28±2.54
t值		0.189	3.159	0.735	0.423	0.703	0.616
P值		0.850	0.002	0.464	0.673	0.484	0.540

组别	例数	Scr（μmol/L）		β₂-MG（mg/L）		ALT（U/L）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	46	749.35±132.68	528.14±109.65^a	27.46±8.19	21.54±6.28^a	17.43±4.86	16.98±4.35
对照组	47	754.06±135.43	534.27±106.82^a	27.95±8.37	21.03±5.96^a	17.09±4.52	17.24±4.61
t值		0.169	0.273	0.285	0.402	0.349	0.312
P值		0.866	0.785	0.776	0.689	0.728	0.756

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