Survey Of Anemia Status And Influencing Factors In A Single Center Cohort Of Maintenance Hemodialysis Patients

Objective:1.To investigate the incidence,degree,cause and drug treatment of anemia in patients with single center maintenance hemodialysis（MHD）;2.To explore the factors affecting the failure of hemoglobin（Hb）in patients with MHD,so as to provide a theoretical basis for improving the rate of Hb and the prognosis of patients.Methods:According to the inclusion criteria,230 MHD patients dialyzed in the blood purification center of our hospital from May 2021 to August 2021 were included as the research objects.Inclusion criteria:（1）maintenance hemodialysis for 3 months or more;（2）Age≥18 years old.Exclusion criteria:（1）severe gastrointestinal bleeding and other acute blood loss in recent 6 months;（2）History of blood transfusion in recent 6 months;（3）Hematological tumors;（4）Hemolytic anemia;（5）Severe infection;（6）Complicated with liver disease,chronic hypoxia and malignant tumor;（7）The clinical data are incomplete.The clinical history data of patients were collected:age,gender,primary disease,dry weight and body mass index（BMI）;age of dialysis,mode of dialysis,weekly dialysis frequency,vascular access and use of anticoagulant;use of erythropoiesis stimulants（ESAs）,iron,folic acid,vitamin B12,L-carnitine and other drugs.Collect the laboratory indexes of patients:Hb,leukocyte count,percentage of neutrophils,platelet count,serum urea nitrogen（BUN）,serum creatinine,serum uric acid,serumcalcium ion(Ca²⁺),serum phosphorus ion,serum iron,serum magnesium ion(Mg²⁺),serum ferritin,transferrin saturation（TSAT）,total iron binding capacity（TIBC）,serumintact parathyroid hormone（iPTH）,serumtriglyceride,serumtotal cholesterol（TC）,serumLow density lipoprotein cholesterol（LDL-C）,serumhigh density lipoprotein cholesterol（HDL-C）,serum total bilirubin,direct bilirubin,indirect bilirubin,serum C-reactive protein（CRP）,etc.Themalnutrition inflammation score（MIS）was collected by questionnaire,physical examination and laboratory examination.The selected patients were divided into non-standard group（Hb<110 g/L）and standard group（Hb≥110 g/L）according to Hb level.Univariate analysis was carried out on the clinical history data,laboratory indicators and MIS of patients,and the differences of relevant factors between the two groups were compared.Binary logistic regression analysis was carried out on the relevant factors with statistically significant differences in univariate analysis,and finally the factors affecting the Hb compliance rate of MHD patients were obtained.Results:The results of this study showed that:1.The prevalence of anemia in MHD patients was about 96.0%,the standard rate of Hb was 46.5%,and the rate of reaching the standard of iron metabolism index was 37.4%.;2.The results of univariate analysis showed that there were significant differences（P<0.05）in dialysis age（χ2=10.846,P=0.004）,dialysis mode（χ2=6.601,P=0.037）,MIS（Z=-3.197,P=0.001）,serumBUM（Z=-1.996,P=0.046）,serum Ca²⁺（Z=-2.099,P=0.036）,blood Mg²⁺（Z=-2.131,P=0.033）,serum albumin（Z=-2.084,P=0.037）,TC（Z=-2.587,P=0.01）,LDL-C（Z=-2.17,P=0.03）between MHD patients with anemia in hemoglobin up to standard rate;3.The results of binary logistic regression analysis showed that high MIS（OR=1.141,95%CI:1.016-1.28）and high serum BUN level（OR=1.059,95%CI:1.006-1.115）were independent risk factors affecting the Hb up to standard rate in patients with MHD.High serum Mg²⁺level（OR=0.114,95%CI:0.015-0.897）is a protective factor.Conclusion:1.The incidence of anemia in patients with MHD is high,and the rate of reaching the standard of Hb after treatment is slightly higher than that of the whole country,and the rate of reaching the standard of iron metabolism index is on the low side;2.The age of dialysis,mode of dialysis,MIS,serum BUN,serum Ca²⁺,serum Mg²⁺,serum albumin,TC,LDL-C were correlated with the standard rate of Hb in patients with MHD complicated with anemia;3.High MIS score and high serum BUN level are independent risk factors affecting Hb compliance rate in MHD patients,while high serum Mg²⁺ level is a protective factor.