Analysis Of Related Factors On Nutritional Status In 147 Maintenance Hemodialysis Patients

Objective: To find better nutritional status, and investigate the effects of residual renal function,dialysis adequacy and microinflammation on nutritional status in maintenance hemodialysis patients.Methods: Clinical features of 147 maintenance hemodialysis patients in the second affiliated hospital of Dalian Medical University were enrolled between July 2010 till Febrery 2011. Nutritional evaluation included MQSGA, Hb, BUN, Alb, CHOL, TG, HDL - C, LDL - C, SF, DEI, DPI, nPCR and anthropometrics such as height, weight, BMI, TSF, MAC, MAMC, AMA. The average value of urine volume in 3 days was measured to investigate the residual renal function. Correlated indexes of hemodialysis adequacy PTH and Kt/V, correlated indexes of microinflammation CRP and PCT were determined in all the subjects. The relevant factors were analysed.Results: 147 maintenance hemodialysis patients included 86 males and 61females. The mean age was (63.08±11.69) years, and the mean dialysis time was (33.84±23.68) months. 147 patients were divided into three groups according to MQSGA: group A(84 cases), group B(55 cases), group C(8 cases). Abnormal rates of all nutritional status were significant among the three groups. There were significant correlations of residual renal function to MAMC, Alb, Hb, nPCR and MQSGA within the first year of hemodialysis. There were different correlations of Kt/V and PTH with MAMC, DPI, Hb, Alb, CHOL, nPCR and MQSGA. CRP had negative correlation with Hb, Alb and nPCR. PCT had positive correlation with MQSGA,and negative correlation with MAMC, DPI, Alb and CHOL. PCT had significant difference between Alb≥37g/L groups and Alb<37g/L groups(P<0.05), and no significant change in CRP. PCT and CRP had significant difference between Alb≥35g/L groups and Alb<35g/L groups(P<0.05), as well as PCT between Hb≥90g/L groups and Alb<90g/L groups(P<0.05). Conclusions: 1. In maintenance hemodialysis patients, modified quantitative subjective global assessment is appropriate for grouping of nutritional status, but mainly for severe malnourished patients. It may be better for nutritional status with modified quantitative subjective global assessment, diet protein intake, Hemoglobin, albumin, cholesterol, normalization protein catabolic rate and mid– arm muscle circumference in maintenance hemodialysis patients. 2. Hemodialysis adequacy and residual renal function in the first year of hemodialysis have significant influence on nutritional status. 3. Procalcitonin and C– reactive protein may influence nutritional status, and procalcitonin is more sensitive than C– reactive protein.