Study On The Relationship Between Malnutrition,microinflammation And Mortality In Maintenance Hemodialysis Patients

Objective:To investigate the relationship between serum albumin,hypersensitive C-reactive protein and the risk of death in patients with maintenance hemodialysis,we investigated the demographic characteristics and death status of patients with end-stage renal disease in this dialysis center in recent 10 years.To provide theoretical guidance for reducing the death events of maintenance hemodialysis patients.Methods: This study included 166 patients with renal failure who were treated with maintenance hemodialysis from June 2007 to June 2017 at the blood purification center of the second affiliated Hospital of Nanchang University.Collect baseline data of patients,including: name,gender,date of birth,primary disease,dialysis pathway,first dialysis time,last dialysis time,dialysis frequency,dialysis time,complications,survival status,cause of death etc,blood detection indicators include: serum total protein(TP),serum albumin(S-Alb),hemoglobin(HB),serum ferritin(SF),total cholesterol(TC),triglyceride(TG),serum creatinine(Scr),uric acid(UA),intact parathyroid hormone(iPTH),serum calcium(Ca),kalium(K),phosphorus(P),High-sensitivity C-reactive Protein(hs-CRP),erythrocyte sedimentation rate(ESR)etc,performing clinical baseline data analysis and analysis of blood detection indicators.According to the survival status of the patients,the patients were divided into survival group and death group;according to the cutoff value of 35g/l of S-Alb,patients were divided into group A(normal group: S-Alb?35g/l)and group B(low group: S-Alb<35g/l)for statistical analysis;according to the cutoff value of 8mg/l of hs-CRP was divided into group M(increased group: hs-CRP?8mg/l)and N group(normal group: hs-CRP<8mg/l),performed statistical analysis;then,the correlation analysis between the plasma levels of S-Alb,hs-CRP and other indicators were analyzed,according to S-Alb combined with hs-CRP is divided into a group 1(reduced S-Alb <35g / l,increased hs-CRP ? 8mg / l),groups 2(reduced S-Alb <35g/ l,normal hs-CRP<8mg/l),groups 3(normal S-Alb?35g/l,elevated hs-CRP?8mg/l),groups 4(normal S-Alb?35g/l,normal hs-CRP <8mg/l),baseline data analysis andblood test index analysis.Finally,the differences in mortality risk among dialysis patients under different groups were analyzed.Results: There were 109 males and 57 females with an average dialysis age of25.09 ±18.54.The first three primary diseases were as follows: hypertension nephropathy 31.933%,diabetic nephropathy 31.93%,chronic glomerulonephritis28.31%,follow-up 120 months later,127 cases survived and 39 cases died.The most common causes of death were cardiovascular and cerebrovascular diseases,which were divided into two groups according to the level of S-Alb: group A(n = 44),group B(n = 44),group M(n = 106),group N(n = 60),group 1(n = 35),group 1(n = 35),group 2(n = 9),group 3(n = 71),group 1(n = 71),group 4(n = 51).Group 4: 51 cases.The results showed that the mortality rate of low S-Alb group was higher than that of normal S-Alb group,the difference was statistically significant(P < 0.001),the mortality rate of high hs-CRP level group was higher than that of normal hs-CRP level group.The mortality of low S-Alb and high hs-CRP groups was significantly higher than that of the other three groups.The Kaplan-Meier survival analysis showed that both S-Alb and hs-CRP were independent risk factors of death in maintenance hemodialysis patients.Multivariate analysis showed that the risk of death in the first group was higher than that in the fourth group(HR1,1.854,95CI100.563-6.099,P1 = 0.036),but the death risk in the second and third groups was not significantly increased.Conclusion: Lower S-Alb levels and higher hs-CRP levels in maintenance hemodialysis patients are common,the higher the level of hs-CRP is,the lower the level of S-Alb is,and the higher the risk of death is in patients with low S-Alb and high hs-CRP levels.Monitoring the level of S-Alb and hs-CRP can be used as a predictor of the prognosis of maintenance hemodialysis patients and provide important clinical reference value for the long-term survival of maintenance hemodialysis patients.