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Microinflammatory state refers to a condition where patients exhibit low-level, persistent inflammation without obvious local or systemic infection, as indicated by clinical tests.

Although the harmfulness of microinflammation itself is not apparent, it is related to complications during maintenance hemodialysis (MHD) treatment, such as increased cardiovascular complications and malnutrition in MHD patients. Studies have also shown that end-stage renal disease patients may experience microinflammation regardless of whether they undergo dialysis.

Therefore, understanding microinflammation is crucial for MHD patients.

The Dangers of Microinflammation

Anemia: Anemia often coexists with an inflammatory state. During inflammation, erythropoiesis decreases, leading to renal anemia. Additionally, inflammation puts patients in an oxidative stress state, further aggravating renal anemia.

Malnutrition: Malnutrition and inflammation are interrelated. During inflammation, skeletal muscle protein catabolism increases, appetite decreases, and nutrient intake reduces.

Frailty: Due to reduced ability to clear inflammatory mediators, patients are often in a state of microinflammation. Frailty is related to sarcopenia, reduced energy intake, and other factors closely associated with inflammation.

In non-dialysis patients, the incidence of frailty can reach 16%, while in MHD patients, the incidence ranges from 34.3% to 82%. Studies have found that frailty can increase the all-cause mortality rate of CKD patients by 1.95 times.

C-Reactive Protein and Microinflammation

Microinflammation is often diagnosed clinically using C-reactive protein (CRP). A significantly elevated CRP (greater than 10 mg/L) suggests the presence of an inflammatory response.

Studies indicate: MHD patients with hypoproteinemia (serum total protein below 60 g/L or albumin below 35 g/L) are more likely to have elevated CRP levels.

In a study of 50 uremic patients, 33 had CRP values higher than normal, accounting for 66%. Among these, patients with cardiac insufficiency, reduced lung function, and decreased calcitonin levels showed varying degrees of elevated CRP.

Therefore, CRP is a primary indicator for the long-term prognosis of CKD patients, and its elevation suggests chronic inflammation or damage to other organs.

Choosing Advanced Dialysis Techniques

Using better hemodialysis machines, biocompatible dialysis membranes, and strictly controlling dialysis water quality can improve microinflammation. For example, high-flux hemodialysis is recommended. Hemodialysis filtration and high-flux hemodialysis are common methods, but compared to conventional hemodialysis, high-flux hemodialysis uses convection and diffusion principles to remove a broader range of toxins. It can eliminate not only small molecular toxins but also medium to large molecular inflammatory factors, significantly reducing microinflammatory reactions and improving kidney function.

Regular Check-Ups Are Crucial

Some patients, seeing significant improvement with regular treatment, only undergo scheduled dialysis and often skip lab tests. This is a major misconception. Regular lab tests are particularly important as they allow doctors to adjust the hemodialysis plan in real-time and address factors causing elevated CRP, preventing disease progression and maximizing the improvement in patient prognosis and quality of life.

References:

1. Jiang Nan et al. Levels of Reactive Protein in Maintenance Hemodialysis Patients and Related Factors. Chinese Journal of Gerontology, October 2023, Vol. 43.

2. Tian Shaoqiang. Predictive Significance of High-Sensitivity C-Reactive Protein for Long-Term Prognosis in Hemodialysis Patients. Chinese Modern Drug Application, September 2017, Vol. 11, No. 18.

3. Wang Lingping et al. Association of CX3CR1 Gene Polymorphism with Microinflammatory State in Maintenance Hemodialysis Patients with End-Stage Renal Disease. Chinese Journal of Nosocomiology, 2023, Vol. 33, No. 11.

4. Wang Ruihua. Analysis of the Correlation Between Systemic Immune-Inflammation Index and Frailty in Maintenance Hemodialysis Patients. Chinese Journal of Integrative Nephrology, August 2023, Vol. 24, No. 8.

5. Tan Xiaomeng et al. Effects of Low-Flux and High-Flux Dialysis Membranes on Microinflammatory State and Erythropoietin Hyporesponsiveness in Hemodialysis Patients. Laboratory Medicine and Clinical, September 2023, Vol. 20, No. 18.

6. Wan Wenjie et al. Effects of High-Flux Hemodialysis on Microinflammatory Response and Renal Function in Elderly Patients with Chronic Renal Failure. Chinese Journal of Gerontology, March 2020, Vol. 40.

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