Analysis Of Risk Factors And Prognosis Of Protein-energy Wasting In Peritoneal Dialysis Patients

Objective:By discussing the risk factors affecting protein-energy wasting in peritoneal dialysis（PD）patients and its influence on prognosis,this paper provides theoretical support for the prevention and treatment of protein-energy wasting in clinical work and improves poor prognosis.Methods:PD patients who were regularly followed up and stable in the PD center of the second Hospital of Jilin University from January 2018 to December 2019 were selected.All of them underwent routine serological examination,peritoneal balance test,anthropometry and nutritional evaluation on the day of follow-up.According to the diagnostic criteria of protein-energy wasting,it was divided into protein-energy wasting group and non-protein-energy wasting group.The follow-up ended on December 31^st,2020 and the outcome was recorded.Withdrawal from PD was taken as the end-point event of follow-up,that is,all-cause death,hemodialysis,renal transplantation.By using Logistic regression model,the risk factors of happening protein-energy wasting in PD patients were analyzed.Kaplan-Meier survival curve was used to calculate the cumulative composite endpoint survival rate,and multivariate Cox regression was used to analyze the risk factors of PD patients withdrawing from PD.Results:1.Research subjects:A total of 90 PD patients were enrolled in this study,which include 51（56.7%）males,with an average age of（49.29±12.40）years and a median dialysis age of 13.05（6.33,24.24）months.There were 83 patients（92.2%）with hypertension and 27 patients（30.0%）with diabetes.In this study,30 patients had protein-energy wasting,and the incidence of protein-energy wasting was 33.3%.2.Clinical data:Compared with patients with non-protein-energy wasting group,the levels of hemoglobin,blood urea nitrogen,blood creatinine,blood uric acid and blood phosphorus in patients with protein-energy wasting group were lower.However,the Kt/V,high transport and high average transport types of one-week PD accounted for a relatively high proportion,and there was a significant statistical difference（P<0.05）.（P represents the significance level of comparison between groups）3.Logistic regression analysis:Hemoglobin is the independent protective factor for protein-energy wasting in PD patients（OR=0.949,95%CI:0.905-0.975,P<0.001）.For every 1g/L increase in hemoglobin,the possibility of protein-energy wasting in PD patients is reduced by 5.1%.4.Long-term outcome:There was no significant difference between the protein-energy wasting group and the non-protein-energy wasting group in continuing PD,hemodialysis,all-cause death,and kidney transplantation（P<0.05）.（P represents the significance level of comparison between groups）.5.Outcome events and survival analysis:With technical failure and all-cause death as composite endpoints（withdrawal from PD）,Kaplan-Meier survival curve confirmed half-year,one-year,and two-year cumulative composite outcome survival rates of the protein-energy wasting group were 86.7%,83.3%,and 76.5%,respectively.Half-year,one-year,and two-year cumulative composite outcome survival rates of the non-protein-energy wasting group were 95.0%,91.5%,91.5%,respectively.The Log-Rank test results:c2=4.873,P=0.027,which shows that the composite endpoint survival rates of protein-energy group were lower,and there was a significant statistical difference（P<0.05）.（P represents the significance level of comparison between groups）.6.Cox regression analysis:Protein-energy wasting was an independent risk factor for withdrawal from PD（technical failure and all-cause death）（HR=3.373,95%CI:1.077-10.567,P=0.037）.Conclusion:1.Protein-energy wasting is common in PD patients,with an incidence rate of33.3%.2.Hemoglobin is an independent protective factor affecting protein-energy wasting in PD patients.3.Protein-energy wasting is an independent risk factor affecting PD patients to withdraw from PD.Prevention and treatment of protein-energy wasting can improve the prognosis.