| Objective:To evaluate the function of bioelectrical impedance analysis (BIA) for detecting body fluids and nutritional status of maintenance hemodialysis(MHD) patients and normal population. Exploring the clinical value of BIA is in order to find a new index for evaluating the body fluids and nutritional status in MHD patients.Methods:We recruited93cases(49males and44females) of the MHD treatment of stable patients from September2010to May2012at the blood purification center of the First Affiliated Hospital of Yangtze University.109healthy volunteers were as control group. Inclusion criteria:The hemodialysis duration of MHD patients required to be more than3months. They were treated2or3times per week,4or5hours each time. Excluding criteria:those whose limbs were disable and could not stand. Those who had ever explanted metal components in vivo. Control group required no infection, cardiopathy, cerebrovascular disease, respiratory, digestive system, urinary system, endocrine system, metabolic diseases, cancer and other wasting diseases. Excluding criteria:those whose limbs were disable and could not stand. Those who had ever explanted metal components in vivo. The experimental group and control group were divided into two groups according to gender. MHD patients were divided into pre-hemodialysis group(A group), post-hemodialysis group(B group) and the next pre-hemodialysis group(C group). The following indicators were determinated and calculated by Inbody3.0bioelectrical impedance analysis in the MHD patients and normal control group. Body fluid index:1. Extracellular fluid volume accounts for the percentage of body mass(ECV%).2. Intracellular fluid volume accounts for the percentage of body mass(ICV%).3. Total body water accounts for the percentage of body mass(TBW%).4. Extracellular fluid volume/Intracellular fluid volume(ECV/ICV).5.Edema index(ECV/TBV).6.The moisture capacity of the double upper limbs.7. The moisture capacity of the double the lower limbs.8. Impedance values and related to the difference of right arm, left arm, trunk, right leg and left leg at5,50,250,500KHz respectively. Nutrition index: Protein%(protein accounts for the percentage of body weight), Minerals%(minerals accounts for the percentage of body weight), Body fat%(body fat accounts for the percentage of body weight), Muscle mass%(muscle mass accounts for the percentage of body weight), Fat free mass%(fat free mass accounts for the percentage of body weight), Body cells mass%(body cells mass accounts for the percentage of body weight). According to the instrument requirement, the control group should empty the stool and urine before detecting those indicators without strenuous exercise during the same period in the morning. We contrasted the differences of the relevant indicators between the experimental group and the control group and the differences between pre-hemodialysis and post-hemodialysis. All measurement data were expressed as average±standard deviation. Normal distribution was tested. Inter-group differences were tested by the one way ANOVA; Correlation analysis was examined by Pearson correlation.The SPSS19.0software was used in the statistical analysis and calculation. P<0.05was considered statistically significant.Results:1.In the basis of the experimental group and the control group age-matched, there were no differences in male weight and height male, but female weight and height of the experimental group were lower than the control group.(Body weight:males, P=0.487, female, P=0.003; height:male P=0.557, female P=0.003). E.ECV%, ECV/ICV and ECV/TBW were statistically significant among control group, A and B group(P<0.05). The results showed that the control group values the smallest, then followed by B group. A group data was the biggest. Gender did not affect the results. ICV%among the three groups was not statistically significant for male, There were differences between the control group and experimental group for female(P<0.05). A group and B group were statistically significant, the value of control group was less than the experimental group(P<0.05). The variety of TBW%was consistent with male and female. There were differences between the control group and experimental group(P<0.05). A group and B group had no significant. Control group was less than the experimental group(P<0.05).3. ECV%, ECV/ICV and ECV/TBW were statistically significant among A group,C group and B group(P <0.05). A group and C group had no significance. B group was significantly reduced(P<0.05). There was no statistically significance among the three groups of ICV%and TBW%. Gender had no effect on the results.4.The correlation coefficient between Ultrafiltration volume and ICV difference:r=0.441, P<0.001; and ECV difference:r=0.646, P<0.001; and TBW difference:r=0.588, P<0.001; and the right upper limb water difference:r=0.561, P<0.001; and the left upper limb water difference:r=0.421, P<0.001; and trunk water difference:r=0.510, P<0.001; and the right lower limb water difference:r=0.394,P<0.001; and the left lower limb water difference:r=0.462, P<0.001. Ultrafiltration volume was considered as the dependent variable (Y). ICV difference, ECV difference, TBW difference, right upper limb water difference, left upper limb water difference, trunk water difference, right lower limb water difference and left lower limb water difference were considered as independent variables(X1、X2、X3、X4、X5、X6、X7、X8), using multiple regression methods to analyze. ECV difference, right upper limb water difference, right lower limb water difference and left lower limb water difference were the influence factors for ultrafiltration volume.(Regression coefficient:b2=0.927, P=0.002; b4=2.770, P=0.001; b7=-2.927, P=0.012; b8=3.992, P=0.001), the regression equation:Y=0.887+0.927X2+2.770X4-2.927X7+3.992X8. The standardized coefficient between Ultrafiltration volume and ECV difference:r=0.348, P=0.002; and right upper limb water difference:r=0.327, P=0.001; and right lower limb water difference:r=-0.583, P=0.012; and left lower limb water difference.r=0.792, P=0.001.5. Pairwise correlation was analysed between RL500/RL5, RL500/RL50, RL250/RL5, LL500/LL5, LL500/LL50, LL250/LL5and ECV/TBW in the control group.Correlation coefficient between ECV/TBW and RL500/RL5:r=0.897, P=0.000; and RL500/RL50:r=0.924, P=0.000; and RL250/RL5:r=0.889, P=0.001; and LL500/LL5:r=0.898, P=0.000; and LL500/LL50:r=0.946, P=0.000; and LL250/LL5:r=0.872, P=0.000; ECV/TBW of control group was considered as the dependent variable(Y), RL500/RL5, RL500/RL50, RL250/RL5, LL500/LL5, LL500/LL50, LL250/LL5were considered as independent variables(X1、X2、X3、X4、 X5、X6), using multiple regression methods to analyze. RL500/RL50, LL500/LL50were the influence factors for ECV/TBW.(Regression coefficient:b2=0.244, Standardized coefficient:0.294, P=0.003; b5=0.580, Standardized coefficient:0.669, P=0.000), the regression equation:Y=0.244X2+0.580X5-0.401.6. Pairwise correlation was analysed between RL500/RL5, RL500/RL50, RL250/RL5, LL500/LL5, LL500/LL50, LL250/LL5and ECV/TBW in the experimental group, Correlation coefficient between ECV/TBW and RL500/RL5:r=0.061,.P=0.562; and RL500/RL50:r=0.032,P=0.759; and RL250/RL5:r=0.064, P=0.544; and LL500/LL5:r=0.056, P=0.596; and LL500/LL50:r=0.007, P=0.946; and LL250/LL5:r=0.067, P=0.525. ECV/TBW of experimental group was considered as the dependent variable(Y), RL500/RL5, RL500/RL50, RL250/RL5, LL500/LL5, LL500/LL50, LL250/LL5were considered as independent variables(X1、X2、X3、X4、 X5、X6), using multiple regression methods to analyze. The above indicators were unable to enter the equation.7. Intracellular fluid, total body water and trunk water did not reach statistical significance between control group and experimental group. Extracellular fluid, the right upper limb water, the left upper limb water, the right lower water, the left lower water, ECV/TBW, RA5, LA5, TR5, RL5, LL5, RA50, LA50, TR50, RL50, LL50, RA250, LA250, TR250, RL250, LL250, RA500, LA500, TR500, RL500and LL500were statistically significant(all P<0.05).8. Protein%, inorganic salts%, body fat%, muscle%, lean body mass%, body cell mass%had no significant differences between control group, A and B group in male, but it was statistically significant in female. The variety of Body fat%was in the opposite direction in female. Lack of fat may be the main manifestations of malnutrition in MHD patients.9. Protein%, inorganic salts%, body fat%, muscle%, lean body mass%, body cell mass%were not statistically significant among A, B and C group. Gender was not affect the conclusions.10. Proteins, inorganic salts, muscle mass, lean body mass, weight, height, basal metabolic rate and body cell mass of control group and pre-hemodialysis group had no statistical significance. But body fat, obesity, body mass index, upper arm circumference of the free-fat and upper arm circumference were statistically significant. The value of control group was more than the experimental group.Conclusion:1. Relevant conclusions of the body fluids indicators:1.1Malnutrition existed in MHD patients, which was more common in female patients.1.2. Among body fluids indicators, there were differences between MHD patients with normal people, in addition to ICV%in male. Higher values was found in MHD patients. In this study, MHD patients body fluid was overloaded, including intracellular fluid and extracellular fluid.1.3. Ultrafiltration in hemodialysis had main effect on the extracellular fluid, little effect on the intracellular fluid.1.4. The ECV difference, the right upper limb water difference and double lower limbs water difference were the influence factors of ultrafiltration. Ultrafiltration volume and the left lower limb water difference had strong correlated.1.5RL500/RL50and LL500/LL50were influence factors of the value of ECV/TBW in control group, especially in LL500/LL50. There was no correlation between ECV/TBW and the ratio of the lower limbs at each frequency in the experimental group.1.6Intracellular fluids had no difference between control group and experimental group, but extracellular fluid, the right upper limb water, left upper limb water, the right lower limb water, left lower limb water and ECV/TBW in experimental group were higher than control group. RA5, LA5, TR5, RL5, LL5, RA50, LA50, TR50, RL50, LL50, RA250, LA250, TR250, RL250, LL250, RA500, LA500, TR500, RL500and LL500in control group were higher than experimental group.2. Relevant conclusions of the nutrition indicators:2.1A single dialysis treatment had no significant effect on protein%, inorganic salts%, body fat%, muscle%, lean body mass%and body cell mass%. Protein%, inorganic salts%, muscle%, lean body mass%and body cell mass%in the experimental group were larger than the control group in female. That reason might be due to the lighter weight of the experimental group patients. Body fat%was in the opposite direction. Lack of fat might be the main manifestations of malnutrition in MHD patients2.2Protein%, inorganic salts%, body fat%, muscle%, lean body mass%and body cell mass%in A group, B group and C group had no difference between male and female.2.3. Protein, inorganic salts, muscle mass, lean body mass, weight, height, basal metabolic rate and body cell mass had no statistical significance. But body fat, obesity, body mass index, upper arm circumference of the free-fat and upper arm circumference were statistically significant. The data of the control group was greater than that of the experimental group. In this research, the experimental group might exist a fatty malnutrition. |
PDF Full Text Request