Bioelectrical Impedance Assessment Of Nutritional Status In Hemodialysis And Peritoneal Dialysis Patients

Objective:Through the analysis of the relevant data of end-stage renal disease(ESRD)patients undergoing dialysis treatment,the differences of relevant clinical data of dialysis patients in different nutritional and hydration states were discussed.We analyzed the risk factors of malnutrition in patients under different dialysis modalities and compared the differences in the data related to the nutritional status of patients under different dialysis modalities.The results of this study are intended to provide reference for clinical intervention and early guidance to improve the nutritional status of patients.Method:Patients treated with HD in a tertiary care hospital in Changchun and outpatient follow-up patients treated with PD in a peritoneal dialysis center from July 2021 to December 2022 were selected.Serological monitoring,bioelectrical impedance analysis(BIA)and other relevant data were collected,and the nutritional status of the patients was further assessed.(1)According to the Phase angle(PA)measured in BIA as an evaluation index of the nutritional status of dialysis patients,all the included dialysis patients were divided into normal nutrition group(PA≥4.5°)and malnutrition group(PA<4.5°);Using Over-hydration/Extracellular water(OH/ECW)as an indicator of hydration status of dialysis patients,all dialysis patients included were divided into over-hydration group(OH/ECW>0.15)and normal hydration group(OH/ECW≤0.15).The differences of general and dialysis related data,laboratory indexes,anthropometric indexes,BIA derived parameters and heart-related indexes of dialysis patients under different nutritional and hydration states were analyzed.(2)Risk factors of malnutrition in HD and PD patients are analyzed based on different renal replacement patterns,and the nutritional characteristics of patients with different dialysis patterns are identified using 1:1 matching(PSM).Result:A total of 242 patients were included in this study,including 138 males(57%)and 104 females(43%),124 malnourished patients(51.2%),118 well-nourished patients(48.8%),131 patients(54.13%)in the over-hydration group and 111 patients(45.87%)in the normal hydration group.There were 74 patients with PD(30.6%)and 168 patients with HD(69.4%).1.Analysis of clinical indicators of patients with different nutritional statusCompared to the well-nourished group,Proportion of women in the malnutrition group,proportion of patients with diabetes,edema severity,age,malnutrition-inflammation score(MIS),use of 1.5%+2.5%and 2.5%dextrose dialysate,type of high abdominal permeability transport,daily glucose exposure in PD patients,blood glucose,C-reactive protein(CRP),brain natriuretic peptide(BNP),over hydration(OH),Adipose tissue index(FTI),adipose tissue mass(ATM),extracellular water ratio to intracellular water(ECW/ICW,E/I)and left ventricular hypertrophy(LVH)were higher,and the differences were statistically significant(P<0.05).24h total fluid output,grip strength(HGS),hemoglobin,total protein,albumin(ALB),prealbumin,creatinine,uric acid,urea nitrogen,potassium,sodium,calcium,phosphorus,muscle tissue index(LTI),dry body weight(NH weight),lean tissue mass(LTM),body cell mass(BCM),total body water(TBW)and intracellular water(ICW)levels were lower,and the differences were statistically significant(P<0.05).There were no significant differences in other indexes(P>0.05).Pearson/Spearman correlation analysis showed that PA was positively correlated with body mass index(BMI),HGS,LTI,NH weight,LTM,BCM,TBW,ICW,hemoglobin,total protein,ALB,prealbumin,creatinine,uric acid,24h total fluid output and blood pump velocity(BFR).PA was negatively correlated with age,female,edema degree,OH,E/I,blood glucose,CRP,BNP,MIS,history of diabetes,LVH,peritoneal glucose exposure and type of higher peritoneal transport.2、Analysis of clinical indicators of different hydration conditionsCompared to the normal hydration group,Male proportion,systolic blood pressure(SBP),MIS,diabetes mellitus,edema degree,high peritoneal transport type,daily exposure to peritoneal glucose,OH,TBW,ECW,blood glucose,CRP,BNP,LA,LVED,Left Ventricular Mass Index(LVMI)and combined LVH were higher,and the differences were statistically significant(P<0.05).BMI,percentage of patients with HD,Triceps skin-fold(TSF),FTI,NH weight,ATM,PA,hemoglobin,total protein,ALB,prealbumin,potassium,calcium,serum transferrin,serum transferrin binding capacity,total cholesterol,triacylglycerol,low density lipoprotein,high density lipoprotein and EF were lower,and the differences were statistically significant(P<0.05).There was no statistical difference in the comparison of other indicators(P>0.05).Pearson/Spearman correlation analysis showed that,OH/ECW was positively correlated with SBP,dialysis mode PD,MIS,history of diabetes,degree of edema,higher peritoneal transport type,peritoneal glucose exposure,OH,TBW,ECW,blood glucose,ferritin,CRP,BNP,LA,LVED,LVMI and LVH.OH/ECW was negatively correlated with female,BMI,FTI,ATM,PA,hemoglobin,total protein,ALB,prea AlB,total cholesterol,triacylglycerol,low density lipoprotein,high density lipoprotein and EF.3.Analysis of risk factors for malnutrition in different dialysis modesMultivariate logistic regression results showed that high OH,relative old age,high CRP and low serum ALB were independent risk factors for malnutrition in HD patients.In PD patients,high OH and a history of diabetes are independent risk factors for malnutrition.4.Comparative analysis of nutrition-related data of patients with different dialysis methodsAfter reducing confounding factors between the groups by PSM,the nutritionrelated indexes of different dialysis methods were compared and analyzed.Compared with HD group,MIS,malnutrition ratio,edema severity,OH,TBW,ECW,E/I,blood glucose,serum creatinine and ferritin levels in PD group were higher,and the differences were statistically significant(P<0.05).The 24h ultrafiltration capacity,total protein,ALB,blood potassium,serum transferrin and serum total iron binding ability of PD group were lower,and the differences were statistically significant(P<0.05).There was no significant difference in other indexes(P>0.05).Conclusion1.Bia-derived parameters are closely related to clinical nutrition-related indicators.Patients with malnutrition are more likely to have excessive fluid load,chronic inflammation,decreased grip strength and left ventricular hypertrophy.Patients with hyperhydration were also more likely to have persistent inflammation,poor nutritional status,fat depletion,and changes in heart function.2.There are different risk factors for malnutrition in different dialysis methods.High OH,relative old age,high CRP and low serum ALB are independent risk factors for malnutrition in HD patients.High OH and a history of diabetes were independent risk factors for malnutrition in PD patients.In addition,high OH is an independent risk factor for the same two dialysis methods.BIA monitoring should be emphasized and fully utilized in clinical practice to assess fluid load of patients and develop a reasonable dialysis regimen.3.The peritoneal transport type and dialysis regimen of PD patients will affect the nutritional status and hydration status of patients.Compared with HD patients,PD patients have lower protein levels,more severe and common fluid overload,and are more likely to suffer from malnutrition.