Assessment Of Nutritional Status In Patients With Maintenance Hemodialysis By Body Composition Analysis

?Objective?To measure body composition in maintenance hemodialysis patients(MHD)with body composition monitor(BCM).To analyse the correlation between body composition index,blood biochemical indexes and malnutrition-inflammation score(MIS)and to discuss the application of bioelectrical impedance analysis for malnutrition assessment in MHD patients.?Method?We select 102 cases of stable patients with MHD and measure their body composition with BCM,measurements include total body water,extracellular water,intracellular water,edema index,body mass index,lean tissue index,fat tissue index,lean tissue mass,adipose tissue mass,and body cell mass.Use the malnutrition inflammation score(MIS)to evaluate the nutritional status in MHD patients.Laboratory data within 3 months are collected,including hemoglobin,serum albumin,triacylglyceride,total cholesterol,intact parathyroid hormone,serum ferritin,total iron binding capacity,hypersensitive C-reactive protein,urea nitrogen,serum creatinine.Patients are divided into two groups,MIS scores <8 points are set as well-nutritional groups,and MIS scores ?8 points are set as malnutritional groups,and general clinical data,laboratory data,and body composition are compared between the two groups.To analyze the correlation between body composition index,Laboratory data and malnutrition-inflammation score(MIS).Use the Logistic regression and ROC curve analysis to evaluate the effect of body composition index on malnutrition in patients with MHD.?Result?1.We recruited 102 MHD patients(63males and 39 females)with an average age of 55.21±16.68 years and average MHD period of 20.00(9.75~45.50)months.The general situation and nutritional score of two groups were compared by gender,and the results showed that there was no statistically significant difference in age,dialysis age,body mass index and MIS score between male and female groups.We used the malnutrition inflammation score(MIS)to evaluate the nutritional status in 102 MHD patients,the average score was(5.98 ± 3.66)points.There were 74 cases(72.55%)with no malnutrition,and 28 cases(27.45%)with malnutrition in 102 MHD patients measured by MIS.2.Compared the well-nutritional group(MIS<8)and malnutritional group(MIS?8)of general clinical data,laboratory data,BCM measurement results.The results showed that there was statistically significant difference between the two groups in age,dialysis age,albumin,serum creatinine,hemoglobin,serum ferritin,hypersensitive C-reactive protein,total iron binding capacity,lean tissue index,edema index,adipose tissue index,lean tissue mass,adipose tissue mass,body cell mass.The remaining indicators showed no significant difference(P <0.05).3.The correlation analysis showed that MIS score was positively correlated with age,dialysis age,serum ferritin,hypersensitive C-reactive protein,edema index,and negatively correlated with BMI,serum albumin,serum creatinine,hemoglobin,lean tissue index,adipose tissue index and body cell mass.Serum albumin was positively correlated with hemoglobin,total iron binding capacity,and lean tissue index,and negatively correlated with age,high-sensitivity C-reactive protein,MIS score,and edema index.The edema index was positively correlated with age,high-sensitivity C-reactive protein,parathyroid hormone,and negatively correlated with serum albumin,creatinine,and hemoglobin.Body cell mass was positively correlated with creatinine,BMI,and hemoglobin,and negatively correlated with age of dialysis,high-sensitivity C-reactive protein,and MIS score.Adipose tissue index was positively correlated with BMI,cholesterol and triglyceride,and negatively correlated with MIS score.Lean tissue index was positively correlated with creatinine,serum albumin,hemoglobin,parathyroid hormone,and negatively correlated with age,age of dialysis,high-sensitivity C-reactive protein,and MIS scores(P <0.05).4.Logistic regression analysis showed that the increase of adipose tissue index(P=0.002),lean tissue index(P=0.004)and serum albumin(P=0.002)were the protective factors of malnutrition.The increase of serum ferritin(P=0.033)and dialysis age(P=0.001)were the risk factors of malnutrition.5.ROC curve analysis showed that lean tissue index [AUC=0.688(0.570-0.805)](P=0.004),dialysis age[AUC=0.706(0.576-0.836)](P=0.001),serum albumin[AUC=0.780(0.679-0.880)](P=0.00),serum ferritin[AUC=0.675(0.564-0.786)](P=0.007),predicted the occurrence of malnutrition in patients with MHD is feasible.?Conclusion?BCM can accurately evaluate the human body composition of MHD patients,and its index is highly correlated with laboratory indicators and MIS score.BCM is a new way of assessing the nutritional status of patients with MHD and predicting the incidence of malnutrition,it has the advantages of noninvasiveness,simplicity and repeatability.BCM is convenient for diagnosis of malnutrition and provides the basis for clinical adjustment of nutritional support programs and optimization of therapeutic drugs.