Retrospective Analysis Of The Relationship Between Malnutrition-inflammation Complex Syndrome,Hemodialysis Frequency And Clinic Outcome In Maintenance Hemodialysis Patients

Objectives:Previous studies have shown that MICS is closely associated with prognosis in maintenance hemodialysis patients.Thus,to analyze the relationship between malnutrition-inflammation complex syndrome and clinic outcome through retrospective analysis of nutritional and inflammatory indicators in maintenance hemodialysis patients from the Center for Hemodialysis Research of RenJi Hospital,Shanghai Jiao Tong University School of Medicine.Simultaneously,Twice-weekly hemodialysis(HD)is prevalent in our countries.So we also analyze the relationship between hemodialysis frequency,vintage and prognosis in MHD patient.Methods:1)This study enrolled 527 maintenance hemodialysis patients between January 1,2007 and December31,2014 at Renji Hospital,whose dialysis vintage were more than 3 months.Collect all information including demographic data,baseline characteristics,clinic data.All patients were followed up until death,cessation of HD,transfer other centers,kidney transportation or to the end of the study(31 December 2014).They were classified into two groups by presence or absence of MICS.Non-conditional logistic regression analysis was applied to analyze the risk factors for MICS in MHD patients.The survival rate of patients was analyzed by Kaplan-Meier method.Risk factors for prognosis of patients presence of MICS were analyzed by the Cox proportional hazards models.2)Same as part one.They were classified into twice-weekly HD and thrice-weekly HD.Non-conditional logistic regression analysis was applied to analyze the features for twice-weekly HD.At the same time,they were classified into three groups by hemodialysis vintage,that is <5 years,5-10 years,?10 years,comparing the differences among them according to baseline characteristics and clinic data.The survival rate of patients from different teams was analyzed by Kaplan-Meier method.Risk factors for prognosis of patients were analyzed by the Cox proportional hazards models.Results:1)The mean patient age was 64.10±14.76 years and 60.15% were male,median dialysis vintage was 79.17(40.37,135.57)months.441 patients were presence of MICS in all 527,older age,higher BMI(body mass index),longer dialysis vintage and lower hemoglobin were seen in the patients presence of MICS.Multivariable factor non-conditional Logistic regression showed that older age,longer dialysis vintage,and hemoglobin less than 100 gram per liter were independent risk factors associated with MICS.The mortality of patients presence of MICS was obviously higher than patients absence of MICS,no matter all-cause mortality(Log-Rank P=0.040)or CVD mortality(Log-Rank P=0.038)according to Kaplan-Meier method.Older age?longer dialysis vintage?lower hemoglobin?lower total cholesterol?higher low density lipoprotein were independent risk factors for all-cause and CVD mortality in patients presence of MICS by Cox proportional hazards models.2)207 patients of all 527 wree treated with twice-weekly hemodialysis(HD),and 59.90% were male.Higher BMI(body mass index),shorter dialysis vintage and higher proportion in high-flux dialysis,lower blood pressure before dialysis,higher proportion in use of antihypertensive drugs,lower dose of EPO were seen in the patients of twice-weekly HD.Higher blood urea nitrogen before dialysis,higher URR,lowerer hemoglobin,lower transferrin saturation,lower calcium,lower phosphorus,higher high-density lipoprotein,lower triglyceride,higher mean spKt/v were seen in the patients of twice-weekly HD.The multivariable factors non-conditional Logistic regression showed that higher BMI(OR=1.417,P=0.029),shorter dialysis vintage(OR=0.682,P=0.001),higher proportion of the use of high-flux dialysis(OR=2.745,P=0.001),higher phosphorus(OR=1.664,P=0.010),lower calcium(OR=0.723,P=0.041),lower triglyceride(OR=0.659,P=0.048)were features associated for twice-weekly HD patients.For the twice-weekly HD patients whose dialysis vintage less than 5 years was 43.48%,but 31.12% for thrice-weekly HD team.For the twice-weekly HD patients whose dialysis vintage more than 10 years was 21.26%,but 35.31% for thrice-weekly HD team.The differences in baseline characteristics and clinic data between twice-weekly HD and thrice-weekly HD patients were smaller and smaller with the extension of dialysis vintage.The mortality between the different dialysis frequency teams was not obvious no matter all-cause mortality(Log-Rank P=0.250)or CVD mortality(Log-Rank P=0.086)according to Kaplan-Meier method.Twice-weekly HD,older age,longer dialysis vintage,lower hemoglobin,higher low-density lipoprotein,higher high-density lipoprotein,higher hs-CRP,higher ferritin,higher diastolic blood pressure after dialysis were independent risk factors for all-cause mortality in all MHD patients by Cox proportional hazards models.Twice-weekly HD,older age,longer,lower hemoglobin,higher low-density lipoprotein,higher high-density lipoprotein,higher hs-CRP,more ultrafiltration,higher systolic blood pressureafter dialysis were independent risk factors for CVD mortality in all MHD patients by Cox proportional hazards models.Conclusions:1)In MHD patients the prevalence of MICS was high.Poorer prognosis was observed in patients presence of MICS.2)Shorter dialysis vintage,higher BMI,higher ratio of the use of high-flux dialysis,lower calcium,higher spKt/v,higher URR were features for the twice-weekly HD patients.The mortality was no difference between the twice-weekly HD and thrice-weekly HD patients no matter all-cause mortality or CVD mortality.Twice-weekly HD was independent risk factors for all-cause and CVD mortality in all MHD patients.More further studies are needed to analyze the influence between twice-weekly HD and prognosis.