Additional hemoperfusion for patients receiving maintenance hemodialysis: a retrospective analysis

Objective: To determine the efficacy of hemodialysis combined with hemoperfusion with acupuncture on calcium-phosphorus metabolism disorder (CPMD) of patients who had received maintenance hemodialysis and its effect on intact parathyroid hormone (iPTH) and nutritional status. Methods: Data from 142 patients who were treated and given maintenance hemodialysis in Baoji People's Hospital from March 2018 to February 2020 were analyzed retrospectively. Patients treated with hemodialysis and acupuncture-moxibustion adjuvant therapy were enrolled into the control group (n=58), while those treated with hemoperfusion in addition to hemodialysis and acupuncture-moxibustion adjuvant therapy were enrolled into the research group (n=84). The two groups were compared in terms of changes in iPTH, calcium-phosphorus product, serum calcium (Ca), serum phosphorus (P), beta 2 microglobulin (beta 2-MG), serum albumin (Alb), creatinine (Scr) and urea nitrogen (BUN). The clinical efficacy in the two groups was compared after therapy, and the two groups were also compared in the improvement of immune function-related indexes (IgG and IgM) and the changes of nutrition-related indexes (Alb, prealbumin (PA) and hemoglobin (Hb)) before and after treatment. A risk prediction model was constructed based on LASSO regression to evaluate the predictive value of the risk score for efficacy of patients. Results: After treatment, the research group presented significantly lower levels of P, iPTH, and calcium-phosphorus product than the control group, but a significantly higher Ca level than the control group (all P<0.05). In addition, after treatment, the research group showed significantly lower levels of beta 2-MG, Scr and BUN but a higher Alb level than the control group (all P<0.05). After treatment, the research group had a greater improvement in immune function-related indexes (IgG and IgM) than the control group (all P<0.05), while the control group had significantly decreased Alb, PA and Hb after treatment (all P<0.05), but the levels of these in the research group did not change greatly (all P>0.05). Risk scoring formula was constructed: risk score = (dialysis time * 0.057123881) + (Ca * -0.100413548) + (P * 0.100419363) + (calcium and phosphorus product * 0.03872268) + (iPTH * 0.000358779). According to inter-group comparison of risk score, the Improvement group got a lower risk score than the Non-improvement group (P<0.0001). Moreover, according to ROC curve-based analysis, the area under the curve of risk score in predicting the efficacy of patients was 0.991. Conclusion: Hemodialysis combined with acupuncture and blood perfusion can control the immune regulation by increasing the blood calcium content without affecting nutritional status, but it has no significant effect on the efficacy in patients.