| In recent years,the morbidity and prevalence of chronic kidney disease(CKD)is increasing with the increasing of population aging,diabetes,hypertension and other chronic diseases,thus patients who need maintenance hemodialysis(MHD)are also increasing year by year.The efficacy of MHD on patients with end-stage renal disease has been increasing,but it could not completely replaced all the complex endocrine and metabolic functions of normal kidneys,and a series of MHD complications may occur.Therefore,it is very important to actively correct the complications of MHD patients to improve the prognosis of patients and improve the quality of life.Objective:Our study aimed to understand the basic situation of MHD patients in our hospital,to evaluate dietary intake of related nutrients,the changes of anthropometry,serum phosphorus,serum calcium,parathyroid hormone and ferritin levels after nutrition intervention,and judge the effect of intervention.The results of this study will produce evidence to evaluate the effect of nutrition intervention on nutritional status in MHD patients.Methods:In this study,we selected 110 patients with MHD from May 2016 to December2016 in the Blood Purification Center of the Fourth Hospital of Jilin University.We selected three parts of data from the medical records system.Firstly,we collected the social demographic data,such as gender,age,ethnicity,education,average monthly income,medical payment,and employment.Secondly,we evaluated the intake of protein,water,potassium,sodium,calcium,phosphorus,and energy in MHD patients.Thirdly,we collected anthropometry,including body mass index(BMI),upper circumference circumference(AC),upper arm muscle circumference(AMC),and triceps skinfold thickness(TSF).Fourthly,we collected disease-related clinical data,including the primary cause of end-stage renal disease,blood phosphorus,calcium,parathyroid hormone(iPTH),and ferritin.We compared the changes of AC,AMC,TSF,BMI,serum phosphorus,serum calcium,parathyroid hormone and ferritin levels in patients with MHD after nutrition intervention.Statistical analysis was performed using SPSS 21.0.Results:(1)basic situation:A total of 110 patients with MHD were included in our study,including 59 males(53.6%)and 51 females(46.4%).There are 30 males in the nutrition intervention group,ratio is54.5%and 25 females(45.5%),There are 29males in the control group,ratio is52.7%and 26 females(47.3%)?The mean age was58.45±12.31 years in the nutrition intervention group,6 cases(10.9%)were young,21 cases(38.2%)were in middle age,and 28 cases(50.9%)were in old age.The mean age was 57.09±12.61 years in the control group,10 cases(18.2%)were young,22 cases(40.0%)were in middle age,and 23 cases(41.8%)were in old age.In this study,Han nationality patients were the most common in the two groups,50 cases(90.9%)in the nutrition intervention group,and 53 cases(96.4%)in the control group;The college and above were the least in the two groups,there were 7 cases(12.7%),and 9 cases(16.4%)in the control group?The cases who were junior high school were the mos,and 24cases(43.6%)in the nutrition intervention group and 20cases(36.4%)in the control group.The most cases were 2500~5000 yuan every month,32cases(58.2%)in the nutrition intervention group and 36cases(65.5%)in the control group?The number of staff in service was the highest in the two groups,with 35(63.6%)in the nutrition intervention group and 30(54.5%)in the control group;The main primary disease of MHD was diabetic nephropathy(35.5%)in two groups,followed by hypertension nephropathy,chronic nephritis,tubulointerstitial lesions,polycystic kidney disease,and others(including lupus nephritis,nephrotic syndrome,and neoplasms).(2)dietary intake of related nutrients:There were no significant differences in dietary intake of related nutrient between the two groups before intervention?The results showed that the intake of protein increased 6.68g/d in the nutrition intervention group after intervention,but there was little change in the control group.There was significant differences in the intake of protein between the two groups(t=-8.408,P<0.001),and the intake of water?potassium?sodium?phosphorus were decreased after nutrition intervention,and there was significant differences between the two groups(z=-6.923 P<0.001,t=-5.752 P<0.001,t=-5.658 P<0.001,z=-3.554 P<0.001),There was no significant differences in calcium and energydietary intake between the two groups(P=0.836,0.742>0.05)?(3)anthropometry:The results showed that the AC and AMC were significantly increased in the nutrition intervention group,however,there was not significantly changed in the control group,there was significant differences in two groups(P<0.001)?The abnormal rate of AC and AMC was not statistically significant before intervention,the abnormal rate of AC and AMC in the nutrition intervention group was lower,and the abnormal rate of the control group was basically stable.after the intervention,the abnormal rates of AC and AMC in the two groups were statistically different(P=0.022,0.035<0.05);the change value and abnormal rate of TSF index did not change significantly in the two groups after intervention(P=0.315,0.768<0.05)?The BMI was not significantly changed in either before or after the intervention in the two groups There was no significant difference in the BMI index between the two groups before and after the nutrition intervention intervention(P=0.969).We also used Chi-square test to compare the distribution of BMI before and after nutrition intervention,and the results showed that there were no significant results(P_?=0.513,P_?=0.562).(5)the changes of the biochemical indicators:The results showed that the blood phosphorus was significantly decreased in the groups,the nutrition intervention intervention group decreased significantly.there was significant differences in blood phosphorus between the two groups(z=-2.119,P=0.036<0.05)?The blood calcium intake increased in the nutrition intervention group,and the blood calcium did not change in the control group?There was a statistically significant difference in the change of serum calcium(P<0.001).The content of iPTH were decreased after nutrition intervention in the nutrition intervention group,and the intake of iPTH was not significantly changed in the control group,the changes of iPTH intake in the two groups were statistically different(P<0.001)?The content of ferritin were decreased in two groups,We used Wilcoxon rank sum test to compare the levels of the ferritin change between the two groups and We found that there was no significant difference in different groups(P=0.188>0.05).Conclusion:(1)Nutrition intervention intervention can effectively control the daily dietary intake of protein,water,sodium,potassium,and phosphorus in MHD patients.(2)Nutrition intervention has improved the nutritional status of MHD patients in different degrees.,and the improvement of AMC and AC is better.(3)The levels of serum phosphorus,iPTH,were decreased,and the levels of serum calcium is increased by nutrition intervention. |
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