Evaluation Of Nutrition,Volume And Cardiac Function In CAPD Patients By Bioelectrical Impedance Analysis

Objective: Bioelectrical impedance analysis(BIA)was used to evaluate the nutrition and volume status of CAPD patients,and to compare the clinical biochemical indexes under different nutrition and volume status,and to explore the correlation of each index in different nutrition and volume status.At the same time,the relationship among malnutrition,volume overload and cardiac function in CAPD patients was further explored to guide clinical practice.Method: 1.We select 157 patients with CAPD in peritoneal dialysis center of the second hospital of Jilin University during November 2017 and November 2019.The body composition of the patients was measured by BIA system,and the patients were divided into two groups: normal nutrition group(PA34.5°)and malnutrition group(PA<4.5°),Cross section retrospective analysis was used to evaluate the differences of clinical biochemical indicators in different nutritional status,and single factor and multi factor Logistic regression were used to analyze the risk factors of malnutrition.2.We select 157 patients with CAPD in peritoneal dialysis center of the second hospital of Jilin University during November 2017 and November 2019,and the capacity state was evaluated by the over-hydration(OH),the patients were divided into normal capacity group(OH?2L)and capacity overload group(OH>2L),and the dialysis state was comprehensively evaluated by the cross-sectional retrospective survey,and the comparison between the two groups was conducted,The correlation between OH and each index was discussed.3.To explore the changes of cardiac indexes in different volume states,single factor and multi factor Logistic regression analysis were used to analyze the relevant factors affecting left ventricular hypertrophy(LVH),and according to the results,receiver operating characteristic curve(ROC)was used to predict the best point of LVH.Result: 1.Assessment of nutritional status of CAPD patients by BIA(1)The clinical data between two groups in different nutritional status In this study,157 CAPD patients were included.according to the different primary diseases,it can be divided into seven categories: chronic glomerulonephritis(47 cases,29.94%),diabetic nephropathy(36 cases,22.93%),hypertension related renal damage(27 cases,17.20%),polycystic kidney(13 cases,8.28%),interstitial nephropathy(12 cases,7.64%),primary diseases unknown(12 cases,7.64%),and other causes(10 cases,6.37%).the prevalence of malnutrition was 50.96%.There is no statistical significance in the normal group and malnutrition group,such as the age of peritoneal dialysis,e GFR,BMI,history of hypertension,high-sensitivity C-reactive protein,FTI and SGA scores.The age,history of diabetes,blood glucose,OH in the malnutrition group were significantly higher than those in the normal nutrition group(P<0.05),while in the male patients,albumin,prealbumin,urea nitrogen,creatinine,hemoglobin,LTI were significantly lower(P<0.05).(2)Correlation between PA and indicators The bivariate normal distribution showed that PA was positively correlated with albumin,prealbumin,and PA was negatively correlated with age.The bivariate distribution was abnormal.Rank correlation analysis showed that PA was positively correlated with male patients,urea nitrogen,creatinine,hemoglobin,LTI,PA was negatively correlated with history of diabetes,blood glucose and OH.(3)Analysis of risk factors of malnutrition Single factor and two classification logistic regression showed that age,history of diabetes,blood glucose and OH were risk factors of malnutrition in CAPD patients,while male patients,albumin,prealbumin,hemoglobin,creatinine,urea nitrogen and LTI were protective factors of malnutrition.Further multivariate regression analysis suggested that OH was an independent risk factor for malnutrition.2.Assessment of volume states by BIA in CAPD patients(1)The basic data of two groups of patients in different volume States In this study,157 CAPD patients were finally included,including 58 in the normal volume group and 99 in the overload volume group,with the overload rate of 63.06%.In the overall data,86(54.78%)were male,with the average age of 46.69±12.55 years,and the median peritoneal dialysis age of 8(3,21.50)months,In terms of clinical basic information,there was no significant difference in age,age of peritoneal dialysis,history of hypertension,the utilization rate of CCB,the utilization rate of ? receptor blocker,BMI between the normal volume group and the volume overload group.Compared with the normal volume group,the volume overload group were significantly increased in male patients,history of diabetes,and the primary disease was diabetic nephropathy,incidence of edema,blood pressure index,the utilization rate of ARB/ ACEI and diuretics(P<0.05).Clinical biochemical indexes: the type of high peritoneal transport and chloride ion in volume overload group were significantly higher than those in normal volume group(P<0.05),while the levels of serum albumin,calcium ion and hemoglobin were significantly lower than those in normal volume group(P<0.05).In BIA index: OH,ECW,ICW,TBW,E/I of the volume overload group were significantly higher than that of the normal volume group(P<0.05),while PA of the volume overload group was lower than that of the normal volume group(P<0.05).(2)Correlation between OH and various indexes The results showed that OH was positively correlated with diabetes,male morbidity,type of high peritoneal transport,incidence of edema,blood pressure index,and negatively correlated with albumin level and PA.3.The relationship between cardiac function and volume overload in CAPD patients(1)Comparison of echocardiographic results between two groups in different volume states The prevalence of LVH in the volume overload group was 56.57%,significantly higher than that in the normal volume group(24.14%).The LA,IVED,IVST,LVPWT,LVMI,the incidence of mitral regurgitation and aortic regurgitation in the volume overload group were higher than that in the normal volume group(P<0.05).The EF of volume overload group was significantly lower than that of normal volume group(P<0.05).(2)Analysis of the factors influencing LVH Logistic regression analysis showed that OH,systolic blood pressure and diastolic blood pressure were the risk factors of LVH in CAPD patients,and ? receptor blocker,albumin and calcium ion were the protective factors of LVH.Further multivariate regression analysis suggested that OH and systolic blood pressure were independent risk factors for LVH in CAPD patients.(3)The best point of LVH prediction Based on the above findings,there is a clear correlation between systolic blood pressure and OH in the incidence of LVH in CAPD patients,The ROC curve is used to analyze the best point of predicting LVH with systolic blood pressure and OH in CAPD patients.The results showed that when the ROC curve of systolic blood pressure was constructed,the area under the curve was 0.742,and when the ROC curve of OH value was constructed,the area under the curve was 0.740.According to the optimal Jordan index,when the systolic blood pressure was 143 mm Hg,the sensitivity was 72.90% and the specificity was 66.70% in the diagnosis of LVH.When OH was 3.65 L,the sensitivity was 54.30% and the specificity was 81.60% in the diagnosis of LVH.Conclusion: 1.BIA is a tool for early assessment of nutrition status of CAPD patients,CAPD patients is prone to malnutrition.OH is an independent risk factor for malnutrition.To control of volume state is beneficial to improve malnutrition of patients.2.BIA is a tool to evaluate the volume status of CAPD patients,and the phenomenon of volume overload is common in CAPD patients.Volume overload is closely related to malnutrition,history of diabetes and high blood pressure.3.The prevalence of LVH was increased in patients with volume overload,and OH was one of the independent risk factors of LVH.According to ROC curve,when systolic blood pressure is higher than 143 mm Hg or OH is higher than 3.65 L,patients with CAPD are more likely to happen LVH,and the specificity and sensitivity are relatively highest.4.Malnutrition,volume overload and LVH are closely related.The former two interact and cause each other.It is very important to evaluate the early nutrition and volume status of CAPD patients through BIA to prevent LVH.