| Background and purpose:Hemodialysis(HD)is a treatment modality for patients with end-stage renal disease(ESRD)to remove excess water and metabolic waste from the body and maintain electrolyte and acid-base balance.Volume overload is a common complication of Maintenance hemodialysis(MHD)patients.Prolonged volume overload can lead to complications such as increased blood pressure and heart failure,resulting in increased incidence of cardiovascular events and mortality,which can have a significant impact on patients’ quality of life and prognosis.Therefore,accurate assessment of volume status in patients with MHD is helpful for volume management,formulation of good dialysis protocols,and improvement of prognosis.Bioelectrical impedance analysis(BIA)is a method to measure body composition by using different organs and tissues with different electrical conductivity properties.It has a very high consistency with the gold standard isotope dilution method in evaluating the volume status of patients,and has high specificity and sensitivity.Therefore,in this study,the BIA method was used to assess the volume status of MHD patients,to compare the clinical indices and BIA indices in different volume states,to investigate the influencing factors of volume overload and the diagnostic value of BIA indices on the occurrence of volume overload in MHD patients,and to provide a basis for the prevention and treatment of volume overload and to improve the prognosis of patients.Methods:A total of 133 patients with stable condition who underwent MHD in the Blood Purification Center of the First Affiliated Hospital of Henan University from November 2021 to December 2022 were selected.The basic data and biochemical indexes of the patients were collected,and body composition analysis was performed using the BIA method to obtain intracellular water(ICW),extracellular water(ECW),total body water(TBW),phase angle(PA),body cell mass(BCM),skeletal muscle mass index(SMI),fat free mass(FFM),etc.Patients’ volume status was assessed using ECW/TBW and divided into normal volume group(ECW/TBW<0.4)and volume overload group(ECW/TBW≥0.4).Factors influencing volume overload were explored by univariate analysis and binary logistic regression analysis.ROC curves were used to analyse the diagnostic value of the BIA index for volume overload in MHD patients.Results:1.A total of 133 patients with MHD were included in this study,including 73 males and 60 females,and the top three primary disease compositions were diabetic nephropathy,chronic glomerulonephritis,and hypertensive renal damage.The study was divided into a normal volume group(n=50,37.6%)and a volume overload group(n=83,62.4%),with a higher incidence of volume overload in patients with MHD.2.Results of univariate analysis:(1)Basic information: The differences in age,BMI,combined diabetes,combined cardiovascular disease,systolic blood pressure and oedema between the two groups of MHD patients were statistically significant(P<0.05),while the differences in gender,dialysis age,dialysis access type,combined hypertension,use of antihypertensive drugs,diastolic blood pressure and weight gain between dialysis were not statistically significant(P>0.05).(2)Biochemical indexes: The differences in blood creatinine,haemoglobin and albumin between the two groups of MHD patients were statistically significant(P<0.05),while the differences in blood urea nitrogen,sodium,calcium,phosphorus,parathyroid hormone,ferritin,high-sensitivity C-reactive protein and Kt/v were not statistically significant(P>0.05).(3)BIA indicators: The differences in ECW,SMI,50 k Hz PA,BCM between the two groups of MHD patients were statistically significant(P<0.05),while the differences in ICW,TBW,FFM,TBW/FFM,protein,inorganic salt,percentage of body fat and bone mineral content were not statistically significant(P>0.05).3.Pearson or Spearman correlation analysis: Pearson correlation analysis was used when both variables were normally distributed,and Spearman correlation analysis was used when they were not normally distributed.The results showed that ECW/TBW was positively correlated with age,combined diabetes,combined cardiovascular disease,edema status,systolic blood pressure and ECW,and negatively correlated with BMI,blood creatinine,albumin,haemoglobin,SMI,50 k Hz PA and BCM.4.Multi-factor logistic regression analysis: The indicators that were statistically significant in the univariate analysis,including combined diabetes,combined cardiovascular disease,oedema status,age,BMI,systolic blood pressure,blood creatinine,albumin,haemoglobin,ECW,SMI,50 k Hz PA,BCM,were screened for binary stepwise logistic regression analysis(backward likelihood ratio test).The results showed that age,diabetes,and ECW were risk factors for volume overload(P < 0.05),and albumin,50 k Hz PA,and BCM were protective factors for volume overload(P < 0.05).5.Results of ROC curve analysis: ROC curve analysis was performed on the BIA indicators in the binary stepwise logistic regression analysis.The results showed that the area under the curve(AUC)for ECW,50 k Hz PA and BCM were 0.627,0.764 and 0.731 respectively,with 50 k Hz PA having the highest diagnostic value.The AUC for the combination of the three indicators was 0.869,with the combined diagnostic value being better than that of the single indicator.The AUC for the three indicators combined with age,diabetes and albumin was 0.890,0.874 and 0.875 respectively,all of which had an increased diagnostic value.Conclusions:1.The incidence of fluid overload in MHD patients is high,and BIA has high clinical application value in the evaluation of fluid status.2.Age,diabetes and ECW were risk factors for volume overload in MHD patients,while albumin,PA and BCM were protective factors.3.ECW,PA and BCM all have diagnostic value for fluid overload,and the combined diagnostic value is better than any single index. |
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