The DSM-BIA Results Of CKD5 Peritoneal Dialysis Patients Evaluated The Dry Weight And The Correlation Study With TCM Syndrome Types

Objective:Peritoneal dialysis patients’ dry weight evaluation is very important to their survival and prognosis.The methods that be currently and mainly used are clinical evaluation method and Chamney method(which used population-based BMI to get ECW%,and then calculated by formula),But there are some difficulties when they were applied.In recent years,the DSM-BIA method is uesd to assess the dry weight of hemodialysis patients,it is a simple method and has good application values.But the method lacks of data in the application of peritoneal dialysis patients.Therefore,this study aims to research that how does the DSM-BIA method evaluates the CKD5 peritoneal dialysis patients’ dry weight,and the correlation between the body composition result measuring by the DSM-BIA method and TCM syndrome types.To provide more concise method for the dry weight evaluation of peritoneal dialysis patients.At the same time hope that according to the objective DSM-BIA results can provide relatively standardized basis for different TCM syndrome diagnosis.Methods:This study was a prospective design.Between March and December in 2019,patients from dongzhimen hospital and daxing TCM hospital who had entered peritoneal dialysis for more than 3 months due to CKD5 were included in research.Data of the patients were collected:results of human body composition measured by DSM-BIA method,biochemical result of blood,biochemical results of peritoneal dialysis solution,echocardiographic result,BNP and other results.Data of the control group were collected:general data and results of human body composition measured by DSM-BIA.And then,ECW%of different BMI groups were calculated.Compared dry weight calculated by Chamney method with the target dry weight calculated by dsm-bia results in software.Case reports and data results were recorded into the database,and SPSS25.0 and SPSSAU were used for statistical analysis.Results:(1)General situation:The study included 31 pd patients.The average age of the patients is(55.87 ± 12.11)years.The maximum age is 75.The minimum age is 30.In the sample,males accounted for 67.74%and females 32.26%.0%of patients under 30 years of age.Patients aged 30 to 45 accounted for 19.35%,among which 12.90%were males and 6.45%were females.Patients aged 46 to 60 years old accounted for 41.94%,among which males accounted for 32.26%and females accounted for 9.68%.Patients aged 61 to 75 accounted for 38.70%,among which 22.58%were males and 16.13%were females.The mean peritoneal dialysis age of the patients was(33.97±19.88)months,with a maximum of 67 months,a minimum of 3 months and a median of 36 months.Among 310 healthy controls,48.07%were males and 51.94%were females.The proportion under 30 years old was 13.87%,of which 2.90%were males and 11.29%were females.Those aged 30 to 45 accounted for 18.71%,among which 8.71%were males and 10.00%were females.42.26%were aged 46 to 60,among which 23.23%were males and 18.44%were females.Patients aged 61 to 75 accounted for 25.16%,among which 13.23%were males and 11.94%were females.The average age of the patients was greater than that of the control group(P<0.05).(2)DSM-BIA versus Chameny for setting dry weight:The results of DSM-BIA in the control group were analyzed by linear regression analysis.It was found that BMI had positive effects on TBW(P<0.01)and ECW(P<0.01),and negative effects on TBW%(P<0.01)and ECW%(P<0.01).The reference ranges of TBW%and ECW%in different BMI groups and the mean values of ECW%in different BMI groups were obtained by using the control group data.Both TBW%and ECW%were found to be beyond the reference range.The obtained mean values of ECW%in different BMI ranges were taken into the dry weight formula of Chamney method,and the mean values of the dry weight of patients with Chamney method were calculated to be(62.37±10.30).And Chamney dry weight was compared with DSM-BIA dry weight(65.54±10.01)by paired sample t test.It was found that dry weight of DSM-BIA method was larger than that of Chamney method(3.17-1-3.97),and the difference was statistically significant(P<0.01).(3)The Person correlation items of dsm-bia method and Chameny method were used as independent variables to conduct multiple linear regression analysis of dsm-bia method,Chameny method and expected dry weight difference(ridge regression analysis was used if the independent variables had collinearity problems):BMI,TBW,ECW,ICW,TWIES,Pr,MS,BF and SM were taken as independent variables,and dry weight of Chamney method was taken as dependent variables for Ridge regression analysis.The K value was 0.990,and the R2 value of the model was 0.920.When F test was conducted on the model,it was found that the model passed the F test(F=26.920,P=0.000<0.05).LVEED,LVESD,MPAD,S-Cr,S-Ca,S-Cr,PD-P,PD-UREA,PD-UA,PD-Cr were used as independent variables,and dry body weight of Chamney method was used as dependent variable for Ridge regression analysis.The K value was 0.990,and the R2 value of the model was 0.575.When F test was conducted on the model,it was found that the model passed the F test(F=2.706,P=0.028<0.05).9 items such as BMI,TBW,ECW,ICW,TWIES,Pr,MS,BF and SM were taken as independent variables,and DSM-BIA dry weight was taken as dependent variable for Ridge regression analysis.The K value was set as 0.020,and the R2 value of the model was 0.958.The model passed the F test(F=53.321,P=0.000<0.05).Left ventricular end-diastolic diameter(LVEDD),main pulmonary artery diameter(MPAD),S-UREA,S-Cr,PD-K,PD-Na,PD-P,PD-UREA,PD-UA,and PD-Cr were used as independent variables,and DSM-BIA dry weight was used as the dependent variable for Ridge regression analysis.The K value was 0.990,and the R2 value of the model was 0.564.The model passed the F test(F=2.590,P=0.034<0.05).BMI,body fat(BF),S-UA and PD-Na were taken as independent variables,while the expected difference of dry weight was taken as dependent variable for linear regression analysis.The R2 value of model was 0.744,and the model passed the F test(F=18.164,P=0.000<0.05).(4)Results of BNP and echocardiography:The Person correlation analysis of BNP results and echocardiography results showed that BNP results were significantly positively correlated with LVESD(P<0.05),IVST(P<0.05)and ECW/TBW(P<0.05),and negatively correlated with LVSF(P<0.01)and Chamney difference(P<0.05).Patients were divided according to the BNP results,1st group with BNP<350pg/mL,and 2nd group with BNP≥350pg/mL.The independent sample t test was used to study the differences of BNP in 12 items including LVEED,LVESD,LVSF,IVST,MPAD,MFVe,MFVa,PDA,expected dry weight di:fference,Chamney dry weight,dsm-bia dry weight,ECW/TBW,etc.It was found that the two groups showed significant differences in LVEED(P<0.01),LVESD(P<0.01),LVSF(P<0.01),IVST(P<0.05),and MFVe(P<0.05).The mean value of LVEED in 1st group(46.57)was significantly lower than that in 2nd group(54.57).The mean value of LVESD in 1st group(29.71)was significantly lower than that in 2nd group(37.09).The mean value of LVSF in 1st group(36.91)was significantly higher than that in 2nd group(30.75)).The mean value of IVST in 1st group(11.73)was significantly lower than that in 2nd group(14.26).The mean value of MFVe in 1st group(77.27)was significantly lower than that in 2nd group(94.14).Effect size was used to study the difference amplitude.LVEED’s Cohen’s d value was 1.55,LVESD’s Cohen’s d value was 1.58,LVSF’s Cohen’s d value was 1.22,IVST’s Cohen’s d value was 1.06,and MFVe’s Cohen’s d value was 0.884,all of which were large effect sizes.Nonparametric test was used to study the differences in BNP in 5 items including LVEF,Chamney differences,DSM-BIA differences,AVVmax and PVVmax.Different BNP group samples showed no significant difference in 3 items including AVVmax,PVVmax and DSM-BIA method(P>0.05).The BNP group showed significant difference in LVEF(P<0.01)and Chamney method(P<0.05).(5)Analysis results of the relationship between human body composition data measured by DSM-BIA method and TCM syndrome:T test of two independent samples of peritoneal dialysis age in the blood deficiency syndrome group(15.50±15.42 months)and the non-blood deficiency syndrome group(36.70±19.20 months)(P<0.05).Therefore,the difference of peritoneal dialysis age between the blood deficiency syndrome group and the non-blood deficiency syndrome group was statistically significant(P<0.05),and the blood deficiency syndrome group was shorter than the non-blood deficiency syndrome group,and the Cohen’s d value was 1.2.T test results of two independent samples of ECW%in the wet-heat syndrome group(26.22±2.57)and the non-wet-heat syndrome group(24.08 ±1.79)(P<0.05)showed statistically significant differences between the two groups.The wet-heat group was higher than the non-wet-heat group,and the Cohen’s d value was 0.97.The nonparametric test of ECW%between the drowning poison syndrome group(5.67)and the non-drowning poison syndrome group(17.11)(P<0.05)showed a statistically significant difference,and the drowning poison syndrome group was lower than the non-dro’wning poison syndrome group.Non-parametric test analysis results of ECW%in different evil reality syndrome groups(P<0.05)indicated that there were statistically significant differences between at least two groups in each group.Further analysis revealed that there was a significantly difference in ECW%between the damp-heat syndrome group and the drowning-poison syndrome group,and the damp-heat syndrome group was higher than the drowning-poison syndrome group.Conclusion:1.When clinical application of Chamney method,the construction of ECW%reference value in the control group is complicated to obtain reliable reference value due to various factors,while the application of dsm-bia method is more simple in practical operation.2.The dry weight set by DSM-BIA method was heavier than that set by Chamney method about(3.17 ± 3.97)Kg,the two methods is different on the controlling factors of dry weight,Chamney method is more strict at the water load management then DSM-BIA method when set dry weight,and the DSM-BIA method requires a lower BMI Therefore,from the perspective of setting patients’ dry weight,DSM-BIA method is inferior to Chamney method.Maybe the algorithm of the DSM-BIA method for setting patients dry weight target needs to be modified if clinical application is required.3.There was an correlation between the peritoneal dialysis age and blood deficiency syndrome in patients,and the proportion of blood deficiency syndrome in initial peritoneal dialysis patients was higher.4.The ECW%of patients with humid heat syndrome is higher,which,combined with theoretical discussion,suggests that ECW%can provide a reference for the dialectic of TCM in patients with atypical symptoms.