Is it true that lower PTH control is associated with lower levels of inflammatory cytokines in patients with chronic kidney disease?

Abstract

Background: The body of patients with chronic kidney disease (CKD)is in a state of microinflammation, which further aggravates the progression of CKD and the occurrence and development of its complications. The inflammatory state of the body is significantly increased in patients with secondary hyperparathyroidism of CKD.

Methods: Patients diagnosed with chronic kidney disease in the department of Nephrology of Henan Provincial People's Hospital were selected as the experimental group, and 58 normal subjects were selected as the control group. Collecting patient's Clinical date, whole blood of the experimental group and control group was collected, and hs-CRP was detected by enzyme-linked immunosorbent assay. Compare the differences in clinical indicators and serum hs-CRP between the two groups. Taking PTH and hs-CRP as dependent variables, correlation analysis was conducted to clarify the relationship between PTH and hs-CRP, and further curve fitting was carried out.

Results: The levels of hemoglobin, total protein and albumin in CKD group were significantly lower than those in control group (p < 0.001). Alkaline phosphatase, creatinine, uric acid, Cyc and blood phosphorus in CKD group were higher than those in control group, and the P values were 0.016, <0.001, <0.001, <0.001, <0.001, respectively. Blood calcium was lower than control group, p < 0.001. The levels of hs-CRP in CKD group were significantly higher than those in control group, p < 0.001. Serum PTH was positively correlated with serum hs-CRP (r = 0.299, p = 0.002) in a normalized holistic analysis of CKD patients. In order to further clarify the correlation between PTH and hs-CRP, quadratic method was used to conduct curve fitting on PTH and hs-CRP and found that R = 0.361, F = 7.795, p < 0.001. Quadratic method was used to quadratic curve fitting at PTH levels <600 pg/mL, <500 pg/mL, <400 pg/mL, <300 pg/mL and <200 pg/mL, respectively, and it was found that the corresponding R = 0.281, F = 4.158, p < 0.001. R = 0.292, F = 4.397, p < 0.001; R = 0.546, F = 18.456, p < 0.001; R = 0.415, F = 7.471, p < 0.001; R = 0.403, F = 5.220, p < 0.001. It was found that there was no correlation between PTH and hs-CRP in hemodialysis patients and peritoneal dialysis patients. In order to exclude the influence of drug use on the statistical results, after excluding the patients who took over phosphorus binder and calcium binder, curve fitting method was used to find that PTH and CRP were correlated, in peritoneal dialysis group and hemodialysis group, R = 0.953, F = 39.913, p < 0.001; R = 0.448, F = 3.391, p = 0.010 respectively.

Conclusion: CKD patients have the lowest levels of inflammatory factors within a certain range of PTH.

Keywords: Chronic kidney diseases; hs-CRP; inflammation; parathyroid hormone.

Figure 1.

Screening flow chart.

Figure 2.

Curve fitting of PTH and hs-CRP in all enrolled patients (A). Curve fitting of PTH and hs-CRP when PTH <600 pg/mL (B). Curve fitting of PTH and hs-CRP when PTH <500 pg/mL (C). Curve fitting of PTH and hs-CRP when PTH <400 pg/mL (D). Curve fitting of PTH and hs-CRP when PTH <300 pg/mL (E). Curve fitting of PTH and hs-CRP when PTH <200 pg/mL (F).

Figure 3.

Curve fitting of PTH and hs-CRP in peritoneal dialysis patients who were not use calcium–phosphorus binders (A). Curve fitting of PTH and hs-CRP in hemodialysis patient who were not use calcium–phosphorus binders (B). Curve fitting of PTH and hs-CRP in patients who did not use calcium–phosphorus binders with PTH <600 pg/mL (C). Curve fitting of PTH and hs-CRP in patients who did not use calcium–phosphorus binders with PTH <500 pg/mL (D). Curve fitting of PTH and hs-CRP in patients who did not use calcium–phosphorus binders with PTH <400 pg/mL (E). Curve fitting of PTH and hs-CRP in patients who did not use calcium–phosphorus binders with PTH <300 pg/mL (F). Curve fitting of PTH and hs-CRP in patients who did not use calcium–phosphorus binders with PTH <2200 pg/mL (F).