Study On The Etiology Of Changes Of BMI And Serum FGF23 On Readmission In Patients With Maintenance Hemodialysis

Objective:To investigate the changes of Maintenance hemodialysis?MHD?patients in body mass index?BMI??serum Fibroblast growth factor23?FGF23?level?serum calcium(Ca²⁺)?serum phosphorus(P^3-)and serum parathyroid hormone?iPTH?on the effect of patients'readmission?Methods:A one-year prospective study of maintenance hemodialysis patients at the Department of Nephrology Hemodialysis,the First Affiliated Hospital of Nanhua University,collected maintenance hemodialysis at the First Affiliated Hospital of Nanhua University from December 2017 to December 2018.The clinical data of 131 patients treated were divided into admission group and non-admission group according to whether they were admitted to the hospital during the study period.The gender,age,primary disease,dialysis age?from the first dialysis to the enrollment?,medication,dialysis,blood Ca2+,blood P3-,blood iPTH,BMI,blood FGF23concentration changes of the two groups were observed and compared,to explore the risk factors for maintenance hemodialysis patients re-admission,establish a prognosis model for maintenance hemodialysis patients.Result:1.131 patients were observed,11 patients were lost to follow-up,and 120 patients were enrolled.Among them,49 patients were admitted to hospital during the observation period.This experiment aims to focus on the impact of changes in dialysis-related indicators on readmission.According to the gender,age,etiology,dialysis age,blood Ca2+,blood P3-,blood iPTH,BMI,BMI change value??BMI?,FGF23,FGF23 change value??FGF23?and other indicators by Univariate logistic regression analysis screened the influential factors,including BMI change value??BMI?,FGF23 change value??FGF23?,BMI after 1 year,FGF23 after 1 year,and dialysis age.However,by forward stepwise,the BMI and FGF23 and dialysis age after 1year were excluded.It was found that?BMI and?FGF23 had statistical significance for readmission rate?P<0.05?,and then multivariate logistic regression analysis found?BMI,?FGF23 is an independent influencing factor for the prognosis of patients with maintenance hemodialysis?P<0.05?.The ROC curve was used to test the multivariate logistic regression model.When the probability value was taken as the critical value,the sensitivity of the model was 98.6%and the specificity was 77.6%,which indicated that the prediction model was excellent and the test efficiency was good.The patient is at risk of re-admission.Through linear correlation analysis,it was found that?BMI was negatively correlated with?FGF23,and?BMI was a protective factor,and?FGF23 was a risk factor,indicating that an increase in BMI was beneficial to reduce the risk of readmission,and vice versa.2.The reasons for re-admission were cardiovascular disease?31 people?,infection?10 people?,cerebrovascular disease?5 people?,and arteriovenous fistula?3 persons?.The comparison of cardiovascular events with maintenance hemodialysis patients without cardiovascular events found that?BMI and?FGF23 were independent factors influencing the re-admission of cardiovascular events?P<0.05?.?BMI and?FGF23 are negatively correlated,and?BMI is a protective factor,?FGF23 is a risk factor,which means that increase of BMI is prone to cardiovascular events,and vice versa.Conclusion:1.This study demonstrates that a reduction in BMI is an important risk factor for readmission in maintenance hemodialysis patients.Improving the nutritional status of patients has a positive effect on the reduction of related complications and readmission rate in maintenance hemodialysis patients.2.?BMI has a negative correlation with?FGF23,suggesting that FGF23 may be a predictor of the nutritional status of patients.3.?BMI and?FGF23 are independent influencing factors for re-admission of cardiovascular events in patients with maintenance hemodialysis.