Advanced hemodialysis systems: Assessing inflammatory biomarkers,renal analytics,and metabolic stability in elderly patients with chronic kidney disease

Abstract

Background:

Chronic kidney disease (CKD) in the elderly necessitates innovative therapeutic technologies to address systemic complications. Advanced hemodialysis systems, integrating real-time biochemical monitoring and optimized filtration, offer potential enhancements in clinical outcomes, yet their impact on inflammatory pathways and metabolic equilibrium remains underexplored.

Objective:

This study evaluated the efficacy of a next-generation hemodialysis system in modulating inflammatory biomarkers, renal function parameters, and calcium-phosphorus homeostasis among elderly CKD patients.

Methods:

Eighty-four elderly CKD patients were randomized into a control group (standard therapy) and an intervention group (standard therapy + advanced hemodialysis). The intervention utilized a fully automated dialysis machine with bicarbonate dialysate, precision-calibrated blood flow (180–200 mL/min), and real-time metabolic tracking. Serum levels of TNF-α, IL-6, IL-1, hs-CRP, BUN, Scr, β2-MG, calcium, phosphorus, and Ca × P were analyzed pre- and post-intervention using ELISA and biochemical assays.

Results:

The intervention group demonstrated a higher total efficacy rate (85.71% vs. 64.29%, P < 0.05). Post-treatment, significant reductions in inflammatory markers (TNF-α: 1.35 ± 0.24 vs. 4.06 ± 0.42 ng/mL; IL-6: 13.05 ± 1.52 vs. 17.62 ± 2.24 ng/L), renal toxins (BUN: 7.82 ± 1.75 vs. 10.12 ± 2.02 mmol/L; Scr: 401.32 ± 15.76 vs. 489.95 ± 16.14 μmol/L), and phosphorus (1.62 ± 0.34 vs. 2.16 ± 0.46 mmol/L) were observed (P < 0.05). Calcium levels improved (3.19 ± 0.56 vs. 2.26 ± 0.53 mmol/L), alongside stabilized Ca × P products (52.92 ± 5.05 vs. 60.34 ± 7.06 mg²/dL).

Conclusion:

Advanced hemodialysis systems significantly enhance therapeutic outcomes in elderly CKD patients by attenuating inflammation, restoring renal function, and optimizing calcium-phosphorus metabolism. These findings underscore the clinical value of integrating technology-driven dialysis protocols for precision care.

Keywords

advanced hemodialysis technology inflammatory biomarkers renal function analytics calcium-phosphorus homeostasis elderly CKD patients

1. Introduction

Chronic renal failure is a prevalent syndrome arising from diverse chronic nephropathies, which leads to a decrease in glomerular filtration rate and causes metabolic abnormalities and multiple clinical manifestations.¹ Surveys indicate that the prevalence of chronic renal failure ranges from 8% to 10%, with a rising trend observed annually.² Another study revealed that the incidence of this disease in the elderly population is 24.2–38.0%, approximately double that of the general population.³ When the disease occurs, it can cause electrolyte and acid-base disturbances, retention of various metabolic products in the body, and multiple organ damage, thereby significantly compromising the patient's health and vitality.⁴

Currently, the treatment measures for elderly patients with chronic kidney failure mainly include diet, medication, and dialysis therapy.^5–7 The first two methods are conservative therapies, which can moderately attenuate disease progression; however, their efficacy is frequently suboptimal and may give rise to adverse effects.⁸ Hemodialysis is an effective treatment method, which involves slowly drawing blood from the blood vessel access through a corresponding machine, completing blood purification through the dialyzer, and then transfusing the fresh blood back into the body.⁹ Studies have shown that hemodialysis can effectively remove renal toxins and inflammatory factors, relieve symptoms, improve calcium and phosphorus metabolism, and prolong the survival of patients.¹⁰ However, there is a significant lack of clinical studies investigating the integration of hemodialysis with conservative management strategies specifically designed for elderly patients suffering from chronic kidney failure.

The objective of this study was to investigate the efficacy of hemodialysis and its effect on inflammatory factors, renal function, calcium and phosphorus metabolism in elderly patients with chronic renal failure. Through the in-depth study of the effect of hemodialysis, it is anticipated to yield more effective treatment strategies for the elderly patients with chronic renal failure, promote the improvement of clinical indicators, deepen the understanding of hemodialysis practice, and provide guidance for clinical practice.

2. Participants and methods

2.1. Participants

This study involved an overall of 84 elderly patients identified with chronic renal failure, admitted from January 2022 to July 2023. Participants were randomly assigned to the control or observation group, each with 42 individuals. The diagnostic criteria were based on the persistent presence of specific indicators for more than three months.¹¹ (1) albuminuria; (2) abnormal urine sediment results; (3) tubulointerstitial lesions; (4) Presence of histological abnormalities; (5) Identification of structural abnormalities on imaging; (6) History of previous kidney transplantation. Glomerular filtration rate falls below 60 mL/min·1.73m²; meets the diagnostic and staging criteria for chronic kidney failure. Inclusion criteria: (1) consistent with the above diagnostic criteria; (2) age ≥ 65 years; (3) normal cognition and mental state; (4) obtained informed consent from the patients. Exclusion criteria: (1) severe liver dysfunction, systemic infection, or connective tissue-related diseases; (2) acute renal injury or cancer; (3) use of drugs with potential renal toxicity; (4) acute renal failure; (5) poor compliance; (6) underwent relevant indicators in the month before enrollment; (7) pregnant or lactating women.

2.2. Methods

The control group was administered standard therapeutic protocols, which predominantly included the correction of acidosis and anemia, regulation of electrolyte disorders, and prevention of infection, as well as control of blood glucose and blood pressure. They maintained a low-protein, low-fat, low-salt, and high-quality diet. They also took Uremic Clearance Granules, 5 g orally, three times a day, and Bailing Capsules, 2 capsules orally, three times a day, for a continuous treatment period of 3 months.

The observation group received hemodialysis treatment using the same method as in their previous sessions. The procedure involved utilizing a Japanese JMS fully automatic dialysis machine and a CDDS central supply dialysis system. Bicarbonate served as the dialysate, with the blood flow rate meticulously regulated between 180 and 200 mL/min, with the dialysate flow rate held at 500 mL/min. The calcium content in the dialysate was 1.5 mmol/L, and the duration of each dialysis session was 4 h. Hemodialysis was conducted tri-weekly over a sustained treatment period of three months.

2.3. Observation indicators

The efficacy of the treatment was evaluated by measuring serum levels of TNF-α, IL-6, IL-1, hs-CRP, blood urea nitrogen, serum creatinine (Scr), β2-microglobulin (β2-MG), calcium (Ca), phosphorus (P), and the product of calcium and phosphorus (Ca × P) in both groups before and after the intervention. (1) Efficacy: Marked improvement: significant reduction in various symptoms, an increase in creatinine clearance ratio by ≥ 90% compared to before treatment; improvement: certain relief of various symptoms, an increase in creatinine clearance ratio by 30–89% compared to before treatment; no effect: no significant reduction or improvement in various symptoms, an increase in creatinine clearance ratio by < 30% or an increase.¹² Overall effective rate = number of marked improvement and improvement / total number × 100%. (2) Inflammatory factors: 5 mL was acquired both pre- and post-treatment. Following centrifugation, serum samples were analyzed for TNF-α, IL-6, IL-1, and hs-CRP using ELISA techniques. pre-treatment and post-treatment (3) Renal function: 5 mL of fasting venous blood was taken pre-treatment and post-treatment, and BUN, Scr, and β2-MG were determined by a biochemical analyzer (Hitachi 7600, Japan). (4) Calcium-phosphorus metabolism: 5 mL of fasting deoxygenated bloodwas taken pre-treatment and post-treatment, and after centrifugation, the serum was obtained for the determination of Ca and P by a biochemical analyzer (HITACHI CHEMIX-180, Japan), and the product of Ca and P (Ca × P) was calculated.

2.4. Statistical analysis

Data analysis was performed using SPSS Statistics 25.0. Categorical variables were shown as frequencies [n (%)], analyzed with the chi-square test (sample size ≥40, T ≥ 5) or corrected chi-square test (sample size ≥40, 1 ≤ T ≤ 5). Fisher's exact test was used for sample sizes <40 or T < 1. Normally distributed continuous variables were reported as means ± standard deviations and analyzed with the independent t-test. Non-normally distributed continuous variables were presented as medians and interquartile ranges [M (P25, P75)] and analyzed using the Mann-Whitney U test. A p-value below 0.05 was deemed statistically significant.

3. Results

3.1. Comparison of baseline data between the two groups

Table 1 reveals no statistically significant differences in gender, age, or disease duration, primary disease type, and clinical stage between the two groups (P > 0.05), demonstrating their comparability.

Table 1.
Comparison of baseline data between the two groups.

Control Observation

Index group (n = 42) group (n = 42) χ2/t p

Gender [n(%)]

Male 26 (61.90%) 28 (66.67%) 0.052 0.820

Female 16 (38.10%) 14 (33.33%)

Age (years) 68.45 ± 5.32 69.14 ± 5.26 0.596 0.553

Course of disease (years) 5.68 ± 1.32 5.75 ± 1.26 0.272 0.786

Primary disease type [n(%)]

Hypertensive nephropathy 19 (45.24%) 17 (40.48%)

Diabetic nephropathy 12 (28.57%) 13 (30.95%)

Chronic glomerulonephritis 9 (21.43%) 8 (19.05%)

Other 2 (4.76%) 4 (9.52%) None 0.883

Clinical stage [n(%)]

Stage III 21 (50.00%) 23 (54.76%)

Stage IV 21 (50.00%) 19 (45.24%) 0.048 0.827

	Control	Observation
Gender [n(%)]
Male	26 (61.90%)	28 (66.67%)	0.052	0.820
Female	16 (38.10%)	14 (33.33%)
Age (years)	68.45 ± 5.32	69.14 ± 5.26	0.596	0.553
Course of disease (years)	5.68 ± 1.32	5.75 ± 1.26	0.272	0.786
Primary disease type [n(%)]
Hypertensive nephropathy	19 (45.24%)	17 (40.48%)
Diabetic nephropathy	12 (28.57%)	13 (30.95%)
Chronic glomerulonephritis	9 (21.43%)	8 (19.05%)
Other	2 (4.76%)	4 (9.52%)	None	0.883
Clinical stage [n(%)]
Stage III	21 (50.00%)	23 (54.76%)
Stage IV	21 (50.00%)	19 (45.24%)	0.048	0.827

3.2. Efficacy comparison between the two groups

Table 2 shows the observation group had a higher total effective rate than the control group. This suggests that adding hemodialysis improved the effectiveness among elderly patients afflicted with chronic kidney failure.

Table 2.
Comparison of efficacy between the two groups [n(%)].

Group Marked improvement Improvement No effect Total effective rate

Observation group (n = 42) 18(42.86%) 18(42.86%) 6 (14.29%) 36 (85.71%)

Control group (n = 42) 13(30.95%) 14(33.34%) 15 (35.71%) 27 (64.29%)

χ2 4.063

p 0.044

Group	Marked improvement	Improvement	No effect	Total effective rate
Observation group (n = 42)	18(42.86%)	18(42.86%)	6 (14.29%)	36 (85.71%)
Control group (n = 42)	13(30.95%)	14(33.34%)	15 (35.71%)	27 (64.29%)
χ2				4.063
p				0.044

3.3. Comparison of inflammatory factors pre-treatment and post-treatment between the two groups

Table 3 indicated there was no significant difference in serum TNF-α, IL-6, hs-CRP and IL-1, levels between the two groups before treatment. However, post-treatment, the observation group exhibited significantly lower inflammatory factor levels than the control group. This implies that the integration of hemodialysis significantly mitigated the presence of inflammatory factors in elderly patients diagnosed with chronic kidney failure.

Table 3.
Comparison of inflammatory factors pre-treatment and post-treatment between the two groups ( $\bar{x} \pm s$ ).

TNF-α(ng/mL) IL-6(ng/L) IL-1(ng/L) hs-CRP(mg/L)

Group a b a b a b a b

Observation

group (n = 42) 6.61 ± 0.85 1.35 ± 0.24 25.54 ± 4.02 13.05 ± 1.52 5.86 ± 0.78 1.65 ± 0.25 18.04 ± 2.15 6.82 ± 1.36

Control

group (n = 42) 6.52 ± 0.92 4.06 ± 0.42 25.32 ± 3.85 17.62 ± 2.24 5.92 ± 0.85 3.24 ± 0.46 18.12 ± 2.23 12.24 ± 1.88

t 0.424 36.509 0.259 10.927 0.357 19.734 0.174 15.139

p 0.673 < 0.001 0.796 < 0.001 0.722 < 0.001 0.862 < 0.001

	TNF-α(ng/mL)	IL-6(ng/L)	IL-1(ng/L)	hs-CRP(mg/L)
Observation
group (n = 42)	6.61 ± 0.85	1.35 ± 0.24	25.54 ± 4.02	13.05 ± 1.52	5.86 ± 0.78	1.65 ± 0.25	18.04 ± 2.15	6.82 ± 1.36
Control
group (n = 42)	6.52 ± 0.92	4.06 ± 0.42	25.32 ± 3.85	17.62 ± 2.24	5.92 ± 0.85	3.24 ± 0.46	18.12 ± 2.23	12.24 ± 1.88
t	0.424	36.509	0.259	10.927	0.357	19.734	0.174	15.139
p	0.673	< 0.001	0.796	< 0.001	0.722	< 0.001	0.862	< 0.001

Note: a: Before treatment; b: After treatment.

3.4. Comparison of renal function pre-treatment and post-treatment between the two groups

Table 4 shows no observed differences in BUN, Scr, IL-1, and β2-MG levels between groups before treatment. Post-treatment, renal function markers decreased significantly in the treated group, indicating that hemodialysis effectively improves kidney function in older chronic renal failure patients.

Table 4.
Comparison of renal function pre-treatment and post-treatment between the two groups ( $\bar{x} \pm s$ )

BUN(mmol/L) Scr(μmol/L) β₂-MG(mg/L)

Group a b a b a b

Observation group (n = 42) 24.73 ± 5.32 7.82 ± 1.75 875.32 ± 22.54 401.32 ± 15.76 6.38 ± 0.75 1.86 ± 0.25

Control group (n = 42) 24.82 ± 5.48 10.12 ± 2.02 874.86 ± 23.14 489.95 ± 16.14 6.41 ± 0.84 3.82 ± 0.56

t 0.073 5.574 0.092 25.459 0.163 20.642

p 0.942 < 0.001 0.927 < 0.001 0.871 < 0.001

	BUN(mmol/L)	Scr(μmol/L)	β₂-MG(mg/L)
Observation group (n = 42)	24.73 ± 5.32	7.82 ± 1.75	875.32 ± 22.54	401.32 ± 15.76	6.38 ± 0.75	1.86 ± 0.25
Control group (n = 42)	24.82 ± 5.48	10.12 ± 2.02	874.86 ± 23.14	489.95 ± 16.14	6.41 ± 0.84	3.82 ± 0.56
t	0.073	5.574	0.092	25.459	0.163	20.642
p	0.942	< 0.001	0.927	< 0.001	0.871	< 0.001

Note: a: Before treatment; b: After treatment.

3.5. Comparison of calcium-phosphorus metabolism pre-treatment and post-treatment between the two groups

Table 5 indicates no observed differences in Ca, P, and Ca × P levels between groups before treatment. Post-treatment, the observation group demonstrated higher Ca and lower P and Ca × P levels, with significant differences, suggesting that hemodialysis improves calcium-phosphorus metabolism in elderly patients with chronic kidney failure.

Table 5.
Comparison of calcium-phosphorus metabolism pre-treatment and post-treatment between the two groups ( $\bar{x} \pm s$ ).

Ca(mmol/L) P(mmol/L) Ca × P(mg²/dL)

Group a b a b a b

Observation group (n = 42) 1.92 ± 0.42 3.19 ± 0.56 3.15 ± 0.75 1.62 ± 0.34 75.22 ± 9.04 52.92 ± 5.05

Control group (n = 42) 1.88 ± 0.45 2.26 ± 0.53 3.12 ± 0.82 2.16 ± 0.46 75.34 ± 9.12 60.34 ± 7.06

t 0.424 7.766 0.197 6.174 0.059 5.541

p 0.673 < 0.001 0.845 < 0.001 0.953 < 0.001

	Ca(mmol/L)	P(mmol/L)	Ca × P(mg²/dL)
Observation group (n = 42)	1.92 ± 0.42	3.19 ± 0.56	3.15 ± 0.75	1.62 ± 0.34	75.22 ± 9.04	52.92 ± 5.05
Control group (n = 42)	1.88 ± 0.45	2.26 ± 0.53	3.12 ± 0.82	2.16 ± 0.46	75.34 ± 9.12	60.34 ± 7.06
t	0.424	7.766	0.197	6.174	0.059	5.541
p	0.673	< 0.001	0.845	< 0.001	0.953	< 0.001

Note: a: Before treatment; b: After treatment.

4. Discussion

Chronic kidney failure can occur as a result of various kidney diseases progressing toterminal kidney disease, and the older/aging population is a high-risk group for this disease. Due to the decline in organ function and the presence of underlying diseases, acid-base and electrolyte imbalances can easily cause renal dysfunction and increase the risk of this disease.¹³ Correct treatment measures are of great significance in mitigating the advancement of the disease and ensuring the life and health of patients. Previous treatment with conventional medications to control the patient's condition has limitations such as poor efficacy and low safety.^14,15 Therefore, it is imperative to investigate alternative treatment modalities that are more effective and scientifically robust.

This study indicated that the overall effectiveness rate, in the observation group, levels were significantly higher than those in the control group, indicating that hemodialysis improved the efficacy in elderly patients with chronic kidney failure. Shoshtari et al.³ Furthermore, their investigation revealed that hemodialysis produced more optimal outcomes for patients suffering from chronic renal failure, aligns with the current study's findings. Hemodialysis replaces the diseased kidneys with a semi-permeable membrane, effectively removing various harmful and toxic waste from the body and maintaining the internal environment of the body in a stable state, resulting in good treatment effects.¹⁶

Studies have found that chronic kidney failure often leads to a state of low-grade inflammation in the body.¹⁷ Various pro-inflammatory factors can activate the immune system, induce inflammatory factor secretion, worsening the response. IL-6, hs-CRP, TNF-α, and IL-1 are common inflammatory factors, and the higher the levels of these indicators, the more severe the inflammatory response.¹⁸ The observation group showed reduced inflammatory factor levels relative to the control group, after treatment, demonstrating that the addition of hemodialysis effectively removed inflammatory factors in elderly patients with chronic kidney failure. Hemodialysis can remove waste products, reduce toxin accumulation, improve electrolyte imbalance, and alleviate inflammatory reactions during the dialysis period; furthermore, it can also clear some inflammatory factors and alleviate specific types of inflammatory responses.^19,20

Elderly patients with chronic kidney failure are affected by their condition, and their renal function tends to decline. BUN, Scr, and β2-MG are common indicators used to evaluate renal function. The lower the levels of these indicators, the worse the renal function.²¹ After treatment, the observation group showed lower renal function indicators than the control group, indicating that the incorporation of hemodialysis markedly improved renal function in elderly patients suffering from chronic kidney failure. During the dialysis period, the artificial dialyzer can help remove excess waste products and toxins from the body, such as urea, creatinine, and potassium ions, which helps reduce the burden on the kidneys and promotes the improvement of renal function.²²

Normal kidneys can excrete excess phosphorus from the body and accelerate the absorption of phosphorus in the intestines. However, after chronic kidney failure occurs, the kidneys cannot excrete phosphorus normally, leading to an increase in blood phosphorus concentration, which causes hyperphosphatemia. This stimulates the parathyroid gland to secrete a large amount of hormones, accelerates bone resorption, and secretes phosphorus and calcium, leading to osteoporosis and hypocalcemia.^23,24 After treatment, calcium levels in the observation group were higher than in the control group, whereas phosphorus levels and the calcium-phosphorus product were significantly lower. This indicates that the incorporation of hemodialysis significantly improved calcium-phosphorus metabolism in elderly patients suffering from chronic kidney failure. During the entire dialysis period, the dialyzer can help remove excess phosphorus from the body, reduce blood phosphorus concentration, alleviate hyperphosphatemia and hypocalcemia, and maintain calcium-phosphorus metabolism in a balanced state.^25–27

This study selected elderly patients with chronic kidney failure who received treatment at our hospital during a specified timeframe, potentially restricting the selection of the sample. The study used conventional dialysis methods, and the application effects of new blood purification technology are still not fully clear. Long-term follow-up of patients was not conducted, and further analysis is needed on the long-term efficacy of dialysis. Adverse reactions during dialysis were not statistically analyzed. Although it had these limitations, this study provides compelling evidence to support the formulation of targeted treatment protocols for elderly patients with chronic kidney failure. This simple and practical therapeutic approach shows significant potential for widespread clinical application, aiming to optimize patient outcomes and improve key clinical metrics.

Conclusion

In summary, blood dialysis has ideal efficacy for elderly patients with chronic kidney failure, effectively clearing their inflammatory factors and improving their kidney function and calcium-phosphorus metabolism levels. The study's sample representativeness is limited by the focus on elderly chronic renal insufficiency patients treated within a specific timeframe. The effectiveness of novel blood purification techniques remains unclear under the traditional dialysis methods employed. Absence of long-term follow-up restricts analysis of dialysis durability, and adverse effects were not statistically assessed. Nonetheless, the findings offer valuable evidence for tailored treatment strategies in this population, highlighting significant potential for clinical application.

Footnotes

Ethical considerations

This study was approved by the ethics committee of Anhui Medical University Affiliated Anqing First People's Hospital (Approval no. 21-AMU-EC-102). Signed written informed consents were obtained from the patients and/or guardians.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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	Control	Observation
Index	group (n = 42)	group (n = 42)	χ2/t	p
Gender [n(%)]
Male	26 (61.90%)	28 (66.67%)	0.052	0.820
Female	16 (38.10%)	14 (33.33%)	0.052	0.820
Age (years)	68.45 ± 5.32	69.14 ± 5.26	0.596	0.553
Course of disease (years)	5.68 ± 1.32	5.75 ± 1.26	0.272	0.786
Primary disease type [n(%)]
Hypertensive nephropathy	19 (45.24%)	17 (40.48%)
Diabetic nephropathy	12 (28.57%)	13 (30.95%)
Chronic glomerulonephritis	9 (21.43%)	8 (19.05%)
Other	2 (4.76%)	4 (9.52%)	None	0.883
Clinical stage [n(%)]
Stage III	21 (50.00%)	23 (54.76%)
Stage IV	21 (50.00%)	19 (45.24%)	0.048	0.827

Advanced hemodialysis systems: Assessing inflammatory biomarkers,renal analytics,and metabolic stability in elderly patients with chronic kidney disease

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Keywords

1. Introduction

2. Participants and methods

2.1. Participants

2.2. Methods

2.3. Observation indicators

2.4. Statistical analysis

3. Results

3.1. Comparison of baseline data between the two groups

Table 2. Comparison of efficacy between the two groups [n(%)]. Group Marked improvement Improvement No effect Total effective rate Observation group (n = 42) 18(42.86%) 18(42.86%) 6 (14.29%) 36 (85.71%) Control group (n = 42) 13(30.95%) 14(33.34%) 15 (35.71%) 27 (64.29%) χ2 4.063 p 0.044

Conclusion

Footnotes

Ethical considerations

Funding

Conflicting interests

References

Table 2.
Comparison of efficacy between the two groups [n(%)].

Group Marked improvement Improvement No effect Total effective rate

Observation group (n = 42) 18(42.86%) 18(42.86%) 6 (14.29%) 36 (85.71%)

Control group (n = 42) 13(30.95%) 14(33.34%) 15 (35.71%) 27 (64.29%)

χ2 4.063

p 0.044