| Objective:The purpose of this study is to evaluate the nutritional status of CAPD patients,compare the diagnostic value of three evaluation methods,and analyze the risk factors of malnutrition in CAPD patients,so as to provide theoretical basis for guiding clinical work.Methods:This study included 123 patients who received continuous ambulatory peritoneal dialysis in the peritoneal dialysis center of the Department of Nephrology of the hospital since April 2018.SGA score,HgS and SMI were used to evaluate the initial nutritional status of patients,and according to the results,patients were divided into groups(G1,G2;H1,H2;S1,S2).All patients were followed up to November 2019,but some of the patients were lack of information and lost of follow-up.So only 67 patients were included in the final analysis.SPSS statistics 22.0 was used to analyze the data.Pearson correlation analysis and Spearman correlation analysis were used to analyze the correlation between the clinical indicators of CAPD patients and SGA,HGS,SMI.Multivariate logistic regression analysis was used to evaluate the risk factors of malnutrition in CAPD patients.The receiver operator characteristic curve(ROC curve)was used to evaluate the diagnostic value of HGS and SMI for malnutrition.Results:1.67 CAPD patients were included in this study,including 37 males(55.22%),30 females(44.78%),and the ratio of males to females was 1.23:1.Up to the end of the study,5 patients died(7.5%),12 patients underwent hemodialysis(17.9%),6 patients underwent kidney transplantation(8.9%),44 patients continued peritoneal dialysis(65.7%).There were 17 cases who were withdrawn from peritoneal dialysis due to technical failure.The main reasons included:cardiovascular accident in 4 cases(23%),peritoneal dialysis related peritonitis in 5 cases(29%),inadequate peritoneal dialysis in 4 cases(23%),severe infection in 2 cases(12%),malignant tumor in 1 case(6%),peritoneal dialysis fluid in 1 case(6%).2.When SGA used to diagnose malnutrition,the incidence of malnutrition in CAPD patients was 28.36%.The hemoglobin,serum albumin,urea nitrogen,potassium,phosphorus and uric acid in G1 group were significantly higher than those in G2 group.The age and the incidence of peritoneal dialysis failure in the G2 group were significantly higher than those in the G1 group.The differences were statistically significant(P<0.05).3.HGS was used to diagnose malnutrition,and the incidence of malnutrition in CAPD patients was 35.82%.The hemoglobin,serum albumin,urea nitrogen,potassium,phosphorus,and total iron binding capacity of patients in group H1 were significantly higher than those in group H2.The age and incidence of peritoneal dialysis failure in group H2 were higher than those in group H1.The differences were statistically significant(P<0.05).4.SMI was used to diagnose patients with malnutrition and grouped.The incidence of malnutrition in CAPD patients was 28.36%.The serum albumin,urea nitrogen,glucose,serum total cholesterol potassium,phosphorus,and total iron binding capacity of the S1 group were significantly higher than those of the muscle mass reduction group S2,and the age and incidence of peritoneal dialysis failure in the S2 group were higher than that of the S1 group.The differences were statistically significant(P<0.05).5.Correlation analysis showed that:(1)SGA score was positively correlated with age(P<0.05),and negatively correlated with hemoglobin,serum albumin,urea nitrogen,potassium,calcium,phosphorus,and total iron binding capacity(P<0.05).(2)Male HGS is positively correlated with serum albumin and total iron binding capacity(P<0.05);female HGS is positively correlated with urea nitrogen and hemoglobin(P<0.05),and negatively correlated with age,total cholesterol,and triglyceride(P<0.05).(3)Male patients’ SMI is positively correlated with body mass index,serum albumin,urea nitrogen,glucose,potassium,phosphorus,total iron binding capacity(P<0.05),and negatively correlated with age(P<0.05);female patients’ SMI It was positively correlated with urea nitrogen,creatinine,and total iron binding capacity(P<0.05),and negatively correlated with age,total cholesterol,and triglyceride(P<0.05).6.Multivariate logistic regression analysis showed that decreased HGS(OR=0.766,95%CI 0.656-0.894,P=0.001)and decreased serum albumin(OR=0.777,95%CI 0.659-0.917,P<0.001)concentration were independent risk factors for malnutrition in CAPD patients.7.The receiver operating characteristic curve showed that the area under the curve of grip strength diagnosis of malnutrition was 0.801(95CI:0.676-0.925,P<0.05),and the area under the curve of SMI diagnosis of malnutrition was 0.816(95CI:0.668-0.944,P<0.05),suggesting that both values of malnutrition are quite higher.When both are used to diagnose malnutrition in CAPD patients,the area under the curve is 0.827(95CI:0.700-0.954,P<0.05),suggesting that the combined application of HGS and SMI to diagnose malnutrition in CAPD patients is more valuable.Conclusions:1.There is a higher incidence of malnutrition in patients with CAPD.2.Malnutrition can be used as an indicator to predict the technical failure of patients with peritoneal dialysis.3.Multivariate logistic regression analysis showed that the decreased of handgrip strength and serum albumin concentration were independent risk factors for malnutrition in CAPD patients.4.Handgrip strength and skeletal muscle mass index can be used to diagnose malnutrition in patients with continuous ambulatory peritoneal dialysis.And when the two are used together,the diagnostic value is higher. |
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