| Objective:Assess Maintenance hemodialysis(Maintenance hemodialysis,MHD)in patients with dry weight and on patients with MHD dry body weight and the difference between the target group by using bioelectrical impedance analysis(Bioelectric impedance analysis,BIA),to find the related factors affecting patients with dry body weight,and study the effect of dry weight on the cardiovascular system.Method:122 MHD patients who received MHD for more than three months from December 1,2016 to December 31,2018 in the our hospital were selected.By using methods of BIA,they were divided into three groups,namely under-standard group(extracellular fluid volume,ECV≤-1),the standard group(-1<ECV<1)and over-standard group(ECV≥ 1)according to the ECV.Collect their general medical history data(such as gender,age,dialysis for the first time when the primary disease,height,weight,BMI,age of dialysis,etc.),biochemical indicators(hemoglobin,albumin,and albumin,blood sugar,blood fat,sodium,chloride,calcium,phosphorus,urea nitrogen,creatinine,PTH,BNP),Echocardiographic Indicators(left ventricular diastolic diameter(LVED),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(LVEF),left ventricular shortening(FS),early diastolic blood flow peak velocity(peak E),late diastolic blood flow peak velocity(A peak),E/A).Comparative analysis was carried out among the three groups,and univariate analysis was conducted on the influencing factors of underachieving dry weight with the above data.The data was processed using SPSS 21.0 statistical software.Results:1.General information:Among the 122 patients enrolled in this study,30 in the standard group,41 in the under-standard group,51 in the over-standard group,and the dry weight compliance rate was 24.59%.The average age was 58.96±14.00 years.There were 57 males(46.72%)and 65 females(53.28%).According to their primary causes,44 cases with diabetic nephropathy(36.07%),42(34.43%)with primary renal disease(such as chronic glomerulonephritis,IgA nephropathy,nephrotic syndrome,chronic interstitial nephritis,etc.),13(10.66%)with hypertensive nephropathy,4(3.28%)with polycystic kidney,2(1.64%)with allergic purpura nephritis,2(1.64%)with vasculitis,15(12.28%)with others causes.2.Comparison of clinical data among different dry weight groups:The clinical data of the patients in the three groups were analyzed and pairwise compared.It was found that the age of patients in the under-standard group was significantly lower than that in the standard group(56.05±10.34)years old vs(63.10±9.09)years old,and the difference between the two groups was statistically significant(p < 0.01).Comparison between the over-standard group and the standard group,the proportion of male patients in the over-standard group was significantly higher than that in the standard group(31/20)vs(8/22),and the difference between the two groups was statistically significant(p < 0.01).The age of patients in the under-standard group was lower than that in the over-standard group(56.05±10.34)vs(59.39±10.96),and the difference between the two groups was statistically significant(p < 0.05).Proportion of male patients in the under-standard group was lower than that in the over-standard group(18/23)vs(31/20),and the difference between the two groups was statistically significant(p < 0.05).3.Comparison of laboratory parameters among different dry weight groups:Laboratory indexes of the patients in the three groups were analyzed and compared in pairs.It was found that the hemoglobin,albumin,and prealbumin levels of the under-standard group were significantly lower than those of the standard group(p < 0.01).The differences in serum calcium and blood chlorine concentrations between the two groups were statistically significant,and the under-standard group was significantly higher than the standard group(p < 0.01).Comparison between over-standard group and the standard group,there were statistically significant differences in hemoglobin and albumin levels between the two groups,and the levels in the over-standard group were lower than those in the standard group(p < 0.05).There were statistically significant differences in serum calcium,serum sodium concentrations and BNP levels between the two groups,and the levels in the over-standard group were significantly higher than those in the standard group(p < 0.01).Comparison between the under-standard group and the over-standard group,there were statistically significant differences in the levels of proalbumin,BNP and urea nitrogen between the two groups,and the under-standard group was significantly lower than the over-standard group(p < 0.01).4.Comparison of cardiac color doppler ultrasound results among different dry weight groups:Comparison of cardiac ultrasound results between the over-standard group and the standard group,there was a statistically significant difference in LVMI between the two groups,and the LVMI of the over-standard group was significantly higher than that of the standard group(p < 0.01).However,EF,FS and E/A were significantly lower in the over-standard group than in the standard group,with statistically significant differences(p < 0.01).The difference in LVMI between the under-standard group and the over-standard group was statistically significant,and the over-standard group was significantly higher than the under-standard group(p < 0.01).However,EF,FS,A value and E/A in the over-standard group were significantly lower than those in the under-standard group(p < 0.01).There was no significant difference in the results between the under-standard group and the standard group(p > 0.05).5.Analysis of related factors affecting dry weight reaching the standard:Univariate analysis of the effects of clinical and laboratory indicators on dry body weight of patients in the three groups showed that gender was male,primary disease was diabetes,albumin,prealbumin,serum calcium,urea nitrogen,BNP,and sodium were correlated with dry body weight(p < 0.05).Multivariate Logistic regression analysis was performed to analyze the above related factors,and the results showed that after controlling confounding factors,serum sodium concentration(OR=1.202,95CI% : 1.054~1.370)was a risk factor for dry weight control,and BNP(OR=1.001,95CI% : 1.001~1.002)was significantly correlated with dry weight,with statistically significant difference(p < 0.05).Conclusion:1.Most MHD patients still have the problem of dry weight not up to standard,among which,over-standard dry weight is more common.2.When MHD patients with over-standard dry weight,the left ventricular systolic and diastolic functions are decreased,and hypertrophy of the myocardium is easy to occur.3.Blood sodium is a risk factor affecting the standard of dry weight of MHD patients.Blood BNP level was significantly correlated with the change of dry body weight,which could be used as an indicator to reflect the patients’ dry body weight. |
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