Multi-frequency Bioelectrical Impedance Method Was Used To Evaluate The Relationship Between Dry Weight And Blood Pressure Of MHD Patients And TCM Syndromes

Objective:We use multi-frequency bioelectrical impedance(MF-BIA)as the method to evaluate dry weight of maintenance hemdialysis(MHD)patients,monitor the blood pressure before and after dialysis,combine them with TCM syndromes to investigate the correlation between dry weight,blood pressure and TCM syndromes,to provide an objective reference for accurate setting of dry weight for each TCM syndrome.Methods:This study include 89 patients undergoing MHD treatment at the Blood Purification Center of the Dongfang Hospital of Beijing University of Traditional Chinese Medicine from June 1,2017 to March 1,2018,we use cross-sectional study.Patients are diagnosed and grouped base on TCM Syndrome quantification questionnaire.The general data such as gender,age,weight,dialysis age,primary disease,SBP and DBP are measured and recorded in each group.TBW,ECW,ICW and E/I in each group are measured by BCM base on MF-BIA.We analyze the correlation between the distribution of water and blood pressure in each group;compare the differences between before and after dialysis.The body fluid indexes are substituted into the Chamney formula,then compare the calculated dry weights with the clinical dry weights for each group.All datas are entered into Excel and processed using SPSS 20.0 statistical software.Results:① Characteristics of TCM syndromes:TCM syndromes of MHD patients are mainly divided into spleen-kidney yang deficiency(21/89,23.6%)and qi and yin deficiency(17/89,19.1%).② Relationship between TCM syndromes and gender:The spleen-kidney yang deficiency is the most common syndromes among males and females,there is no difference in gender between each group(P>0.05).③ Relationship between TCM syndromes and age:Patients<40 years old are mainly characterized by liver-kidney yin deficiency and qi and yin deficiency.Patients between 41 and 60 years old are mainly qi and yin deficiency,and those aged>60 years are mainly spleen-kidney yang deficiency.There is no difference in age between each group(P>0.05).④Relationship between TCM syndromes and weight:Weights after dialysis are significantly lower in each group(P<0.01),humid turbid is the lightest,the liver-kidney yin deficiency is the heaviest,there is no difference in weight between the groups(P>0.05).⑤Relationship between TCM syndromes and dialysis age:The dialysis age of yin and yang deficiency is significantly longer than spleen and kidney qi deficiency(P<0.05).⑥Relationship between TCM syndromes and primary disease:Chronic nephritis,hypertensive nephropathy and diabetic nephropathy are the three main primary diseases of MHD patients.Chronic nephritis is mostly associated with spleen-kidney yang deficiency(14/34,41.2%).Hypertensive nephropathy is mostly in the liver-kidney yin deficiency(8/27,29.6%),diabetic nephropathy is primarily in the Qi and Yin deficiency(6/20,30.0%).The primary disease in each group is significantly different(P<0.05).⑦ Relationship between TCM syndromes and blood pressure:After dialysis spleen-kidney yang deficiency’s blood pressure increase,others decrease especially yin and yang two deficiency’s SBP and humid turbid’s blood pressure(P<0,05),liver-kidney yin deficiency’s SBP before dialysis is significantly higher than spleen-kidney yang deficiency(P<0.05),qi and yin deficiency’s DBP before dialysis is significantly higher than spleen-kidney yang deficiency(P<0.05),liver-kidney yin deficiency’s SBP after dialysis is the highest,yin and yang two deficiency is the lowest,there is no difference in groups(P>0.05),qi and yin deficiency’s DBP after dialysis is significantly higher than others(P<0.05).⑧Relationship between TCM syndromes and distribution of fluid indexes:TBW after dialysis decrease in each group,significantly in spleen-kidney Yang deficiency,qi and yin deficienc and humid turbid(P<0.05).Yin and yang deficiency is the lowest,before dialysis spleen-kidney yang deficiency is the highest,after dialysis spleen-kidney qi deficiency is the highest.There is no statistical difference between each group(P>0.05);ECW in each group is lower than before dialysis,significantly in qi and yin deficiency,yin and yang deficiency(P<0.05),spleen-kidney yang deficiency,liver-kidney yin deficiency,humid turbid decrease(P<0.01).The highest ECW before dialysis is humid turbid,the lowest is spleen-kidney qi deficiency,the highest ECW after dialysis is liver-kidney yin deficiency,the lowest is yin and yang two deficiency,there is no significant difference between groups(P>0.05);In addition to liver-kidney yin deficiency,others’ ICW slightly decrease after dialysis(P>0.05),the highest ICW before dialysis is spleen-kidney yang deficiency,the lowest is yin and yang two deficiency,the highest ICW after dialysis is liver-kidney yin deficiency,the lowest is yin and yang two deficiency,there is no difference between groups(P>0.05);E/I decrease after dialysis in each group,especially in liver-kidney yin deficiency and humid turbid(P<0.01),the highest E/I before dialysis is liver-kidney yin deficiency,the lowest is spleen-kidney qi deficiency,there is no difference between each group(P>0.05).Qi and yin deficiency significantly higher than humid turbid after dialysis(P<0.05);ICW is the main ingredient in all syndromes,except spleen-kidney yang deficiency;ECW is mainly expressed in all syndromes,more ECW expressed in humid turbid than spleen-kidney qi deficiency(P<0.01),the most ICW expressed is spleen-kidney yang deficiency,the least is liver-kidney yin deficiency.There is no difference among groups(P>0.05).⑨ Correlations between blood pressure and TBW,ECW,ICW:Negative correlation between spleen-kidney qi deficiency and ICW,spleen-kidney yang deficiency,spleen-kidney qi deficiency and TBW;Positive correlation between liver-kidney yin deficiency,humid turbid and TBW,ECW,ICW.⑩ Relationships between calculated dry weights and clinical dry weights:humid turbid is similar in two kinds of dry weight,others are significantly higher than clinical dry weight(P<0.01).Conclusions:① The TCM syndromes of MHD patients are mainly in spleen kidney yang deficiency and qi and yin deficiency.② The blood pressure of MHD patients are related to TCM syndromes.③ The body fluid composition measured by the MF-BIA method can be used to predict and evaluate the dry weight of MHD patients.④The dry weight of MHD patients are related to TCM syndromes.