The Correlation Of Dietary Protein Intake And Prognosis In Patients With Maintenance Hemodialysis

Background:Dietary protein intake is an important factor affecting the prognosis of patients undergoing maintenance hemodialysis.The guidelines for dietary protein intake in hemodialysis patients developed in China are mainly based on the results of foreign studies.Due to the lack of high-quality clinical studies on dietary nutrition in dialysis patients in China,and Chinese patients have huge differences in physical fitness,diet,and pathogenic factors between Europe and the United States countries,the foreign dietary guidelines may not be suitable for Chinese patients.Therefore,it is urgent to conduct a comprehensive and systematic study on the dietary status of hemodialysis patients in China and provide high-quality evidence for formulating dietary guidelines suitable for the Chinese paitients.Objective:The purpose of this study was to investigate the dietary protein intake of patients with maintenance hemodialysis and hemodialysis related indicators,and to investigate the relationship between dietary protein intake and mortality outcomes in maintenance hemodialysis patients.Objects and Methods:We used a multicenter cohort study.From January 2014 to December 2015,patients with chronic kidney disease who met the inclusion criteria for maintenance hemodialysis were screened at hemodialysis centers in eight research centers in Guangdong province.Follow-up were conducted to maintenance hemodialysis patients enrolled in each research center from October 2016 to February 2017.1.Research objectInclusion criteria:1)CKD patients undergoing maintenance hemodialysis at 18-80 years of age,gender is not limited;2)have a better understanding of commun-ication skills;3)could eat normally;and 4)stable clinical conditions.Exclusion criteria:1)Patients refused to cooperate;2)Patients with hyperthyroi-dism or other underlying metabolic diseases;3)Patients with acute infectious diseases;4)Patients with cirrhosis and active autoimmune diseases;5)Patients with severe multiple organ dysfunction;6)patients with advanced cancer;7)Hemodialysis time less than 3 months;8)patients refuse to participate.2.Research methodsAt the time of the initial survey,four investigators with trained and assessed,conducted a survey using a uniform design questionnaire in strict accordance with the Standardized Operating Process(SOP).Subjects completed questionnaires(inclu-ding 3 days 24-hour dietary recalls),physical examinations,and laboratory tests at appropriate research centers.During the follow-up period,4 follow-up personnel who received standard training conducted questionnaires and laboratory tests on the subjects.3D Zhen Ding software was used to calculate dietary protein intake(DPI)and dietary energy intake(DEI).And baesd this,we calculated the dietary protein intake normalized for ideal body weight(NDPI)and dietary energy intake normalized for ideal body Weight(NDEI).All of the analyses were preformed with SPSS 20.0 software package,Empower Stats(www.empowerstats.com,X&Y solutions,Inc.,Boston,MA)and the statistical software packages R(http://www.R-project.org,The R Foundation).Kaplan-Meier method was used to perform univariate survival analysis.COX proportional risk model was used to analyze the association between dietary protein intake and follow-up outcomes in maintenance hemodialysis patients.Result1.Study population basic situation:A total of 1,039 eligible hemodialysis patients were included,with an average age of 54.00±15.11 years,of which male accounted for 57.75%.Patients with diabetes accounted for 26.66%,and patients with hypertension accounted for 85.85%.2.Dietary protein intake in hemodialysis patients:The mean ± standard deviation of standard dietary protein intake normalized for ideal body weight(NDPI)was 1.08±0.34 g/Kg IBW/d.There were about 68.89%of patients with NDPI<1.2 g/Kg IBW/d,16.84%of patients with 1.2≤NDPI<1.4 g/Kg IBW/d,and 16.26%with NDPI≥1.4 g/Kg IBW/d.The NDPI of Male(1.05±0.32 g/Kg IBW/d)was lower than female(1.12±0.37 g/Kg IBW/d),and P<0.001.3.Analysis of mortality-related factors in hemodialysis patients:The median follow-up time was 28.02 months.The all-cause mortality rate was 22.48%.Among them,140 patients died of cardiovascular and cerebrovascular diseases,and the cardiovascular mortality rate was 13.47%,Univariate analysis of all-cause mortality in maintenance hemodialysis patients showed that age≥55 years old,diabetes,hypertension,history of cardiovascular and cerebrovascular diseases,anemia(hemoglobin<110g/L),hypoalbuminemia(white Protein<35g/L)and protein-energy expenditure(PEW)were risk factors for all-cause mortality in maintenance hemodialysis patients.Multivariate analysis adjusted the study center,age,gender,diabetes,hyperten-sion,previous cardiovascular and cerebrovascular events,body mass index,serum albumin levels,hemoglobin,total cholesterol,triglycerides,C-reactive protein,calcium-phosphorus product,dialysis age After the potential confounding factors such as Kt/V ratio and NDEI,the results showed that:compared with NDPI(1.2-1.4 g/Kg IBW/d),the all-cause mortality risk ratio(HR)of NDPI(<1.2 g/Kg IBW/d)was 1.63(95%CI:1.05-2.54;P=0.030),and the cardiovascular-related mortality risk ratio(HR)was 2.03(95%CI:1.10-3.73;P=0.023).Conclusion:1.Currently,dietary protein intake in maintenance hemodialysis patients in China is generally lower than the current guideline standard;2.Low dietary protein intake(NDPI<1.2 g/kg IBW/d)was an independent risk factor for all-cause mortality and cardiovascular-related mortality in maintenance hemodialysis patients.