Investigation Of Protein-energy Wasting In Maintenance Hemodialysis Patients And Its Effect On Quality Of Life

Background and ObjectiveWith the continuous improvement of blood purification technology and greatly support of health insurance policy,the effect of end-stage renal disease patients treated with maintenance hemodialysis is significantly improved.However life expectancy is extremely low compared with that of the general population and patient survival remains an important issue.Malnutrition is one of the main causes for high mortality.There were a variety of nutritional indicators and scoring tools in the past.In 2008,the International Society for Renal Nutrition and Metabolism(ISRNM)proposed a nomenclature and diagnostic criteria to identify protein-energy wasting in patients with acute or chronic kidney disease.PEW is an independent risk factor for mortality in HD patients.The diagnosis of PEW earlier is important to take relevant intervention to improve the prognosis.The nutritional status of MHD patients attracts lots of clinicians attention,but also be the urgent problem to be solved.Examined the nutritional status of MHD patients by means of body composition monitor,body measurement and biochemical examination.Evaluated the prevalence of PEW and explored factors associated with PEW.And assessed the impact of PEW on quality of life.Materials and methodsAccording to inclusion/exclusion criteria,selected adult patients who receiving HD treatment three times per week and being stabilised at a minimum of 3 months before enrolment.Written informed consent was obtained from all patients.All patients who met the criteria were followed three times for six monthes,the first follow-up in June 2015 included the collection of basic information,blood was drawed in the midweek both before and after hemodialysis for the laboratory tests,body composition monitor(BCM)and body measurement were performed before hemodialysis;and the normalized protein catabolic rate(nPCR)was calculated to understand the dietary intake.The Kidney disease and quality of life(KDQOLTM-36)were applied to measure the quality of life.The second and third followed-up were carried out in September and December 2015.And the consent were same as the first follow-up.Based on the diagnostic criteria of PEW calculated the prevalence of PEW,and categoried into two groups as PEW and non-PEW respectively.We compared the characteristics and relevant data collected above between the two groups.PEW as the result variable,established logistic regression model to find factors associated with PEW.Results1.Of the 194 MHD patients,57.7% of the patients(112 cases)were male.The mean age was 50.84±14.27 years and the median dialysis vintage was 35(15,60.5)monthes.The prevalence of groups that meets ?3 PEW parameters were 40 cases(20.6%).2.The group of PEW tended to have older ages,lower predialysis blood urea nitrogen,serum creatinine,triglyceride,blood phosphorus,single pool urea clearance index(spKt/V)and higher c-reactive protein(P<0.05).While gender,dialysis vintage,hemoglobin,primary disease were diabetic nephropathy,hypertension,parathyroid hormone and ferritin were no significance in two groups.3.The indicators of muscle lik lean tissue index(LTI),body cell mass(BCM)decreased in the PEW group(male: P=0.019,0.014;female: P=0.075,0.041).While the fat indicators like fat tissue index,adipose tissue mass,fat adipose tissue all had no significant difference between two groups.Indicators of body measurement like mid-arm muscle circumference,hand-grips were significantly decreased in the PEW group(male: P=0.034,0.048;female: P=0.004,0.009),The mid-arm circumference deceased in PEW than non-PEW(male P=0.118;female:P=0.008),the triceps skin fold were lower than non-PEW,but the difference had no significance.As for body fluid,the group of PEW had lower total body water and intracellelar water(P=0.006,0.007),higher E/I and overhydration(P=0.002,0.008).4.The result of Logistic regression showed that spKt/V>1.2,nPCR>0.8g/kg/d were the protect factors(OR=0.64,0.02;P<0.029,0.000)while CRP was the risk factor for PEW[OR:1.06,95%CI(1.02,1.10),P=0.001].5.In KDQOLTM-36,all dimensions in patients with PEW were lower than non-PEW group.Especially general health(30.66 ± 13.57 vs 43.14 ± 16.32,P=0.018),social emotions(39.67±40.90 vs 59.79±42.34,P=0.012),energy/fatigue(34.74±24.09 vs 50.35±26.35,P=0.020),symptoms/problems(67.35±13.74 vs 80.25±15.06,P=0.001)were significantly lower in patients with non-PEW.Conclusions1.The prevalence of PEW in Zhengzhou was 20.6%;The characteristics of PEW may be the wasting of muscle tissue.2.Kt/V>1.2,nPCR>0.8g/kg/d were the protect factors,and CRP was the risk factor for PEW in MHD patients.3.The quality of life in PEW was poor than non-PEW patients.