Study On The Correlation Between Bioelectrical Impedance Analysis Index And Protein Energy Consumption In Maintenance Dialysis Patients

Research Purpose:To investigate and analyze the status quo of Protein-energy wasting(PEW)in maintenance dialysis patients,and to discuss and analyze the relationship between BIA and other nutritional indicators and PEW,so as to provide a convenient and objective PEW assessment tool for clinical nursing workers.Research Methods:In this study,convenience sampling method was used to select 675 patients with maintenance dialysis from a class a hospital in a city of zhejiang province.General data and biochemical test results of the patients were collected,and anthropometric and BIA measurements were performed at the same time.Correlation analysis of BIA index with other nutritional indexes;According to the diagnostic criteria of the international society of renal nutrition and metabolism(ISRNM),the patients were divided into the PEW group and the non-PEW group.The receiver operating characteristic curve(ROC)was used to analyze the predictive effect of meaningful BIA predictors on PEW in patients with maintenance dialysis.Research Results:1.Maintenance dialysis patients PEW incidence was 22.7%,there were 153 PEW patients,the diagnostic criteria of ISRNM state of the nutritional indexes including albumin<38 g/L with 197patients,prealbumin<300 mg/dL with 135 patients,cholesterol<2.59 mmol/L with 48 patients,BMI<23 kg/m~2 with 436 patients,upper arm muscle circumference three months fell by 5%or10%drop in six months with 41 patients,standardized protein decomposition rate(nPCR)<0.8g/(kg·d)with 147 patients.2.The correlation analysis between BIA and other nutritional indicators showed that Fat Free Mass(FFM)was associated with triceps skin fold thickness,albumin,creatinine,BMI,upper arm circumference and upper arm muscle circumference,which was statistically significant(P<0.05).Body Fat Percent(BFP)was significantly correlated with creatinine,prealbumin,cholesterol,hemoglobin,BMI,upper arm circumference,and triceps skin fold thickness(P<0.05).Body Cell Mass(BCM)was correlated with albumin,prealbumin,creatinine,urea nitrogen,BMI and upper arm circumference,which was statistically significant(P<0.05).water ratio(ECW/TBW)was correlated with albumin,prealbumin,nPCR,hemoglobin,creatinine,urea nitrogen,upper arm circumference,upper arm muscle circumference,and tricep skin fold thickness,which was statistically significant(P<0.05).External Cell Water(ECW)was correlated with albumin,prealbumin,cholesterol,nPCR,hemoglobin,tricep skin fold thickness,creatinine,BMI,upper arm circumference and upper arm muscle circumference,with statistical significance(P<0.05).3.By comparing various indicators between the non-PEW group and the PEW group,the age,dialysis age,ECW/TBW,and ECW of the non-pew group were lower than that of the PEW group,with statistical differences(P<0.05).Hemoglobin,urea nitrogen,upper arm circumference,triceps skin fold thickness,FFM,BFP and BCM in the non-PEW group were higher than those in the PEW group,with statistical differences(P<0.05).4.Logistic regression analysis results showed that,FFM(OR=0.895,95%CI:0.873~0.917),BFP(OR=0.951,95%CI:0.926~0.976),BCM(OR=0.883,95%CI:0.847~0.883)and ECW(OR=1.572,95%CI:1.395~1.777)were the influencing factors of PEW,while urea nitrogen(OR=0.909,95%CI:0.871~0.949)and hemoglobin(OR=0.970,95%CI:0.953~0.988),c-reactive protein(OR=1.029,95%CI:1.003~1.055),age(OR=1.026,95%CI:1.004~1.049)and dialysis age(OR=1.015,95%CI:1.007~1022)were the influencing factors of PEW.5.According to ROC analysis,the area under curve(AUC)of FFM was0.585(95%CI:0.535~0.635,P<0.05),and the sensitivity and specificity were 33.1%and 85.6%,respectively.The AUC of BFP was 0.656(95%CI:0.611~0.701,P<0.05),and the sensitivity and specificity were 51.0%and 88.9%,respectively.The AUC of BCM was0.706(95%CI:0.661~0.752,P<0.05),and the sensitivity and specificity were 55.6%and 73.2%,respectively.The AUC of ECW was 0.640(95%CI:0.611-0.701,P<0.05),and the sensitivity and specificity were 80.1%and 51.0%,respectively.The AUC of the combined prediction of BIA was0.864(95%CI:0.834~0.894,P<0.05),and the sensitivity and specificity were 80.4%and 77.6%,respectively.The AUC of four indexes combined with albumin was 0.921(95%CI:0.898~0.945,P<0.05),the sensitivity and specificity were 86.3%and 87.5%,respectively.The AUC of four indexes combined with albumin was 0.898(95%CI:0.873~0.923,P<0.05),the sensitivity and specificity were 83.0%and 82.4%,respectively,and the AUC of four indexes combined with cholesterol was 0.866(95%CI:0.836~0.895,P<0.05).The sensitivity and specificity were 74.5%and 84.0%,respectively;the AUC predicted by four indexes combined with BMI was 0.883(95%CI:0.853~0.913,P<0.05),the sensitivity and specificity were 78.4%and 87.7%,respectively;the AUC predicted by four indexes combined with nPCR was 0.905(95%CI:0.880~0.931,P<0.05),the sensitivity and specificity were 82.9%and 82.0%,respectively.Research Conclusion:1.The high incidence of PEW in maintenance dialysis patients is worthy of attention,and medical staff should adopt treatment and nursing measures according to the characteristics of PEW.2.BIA indexes such as FFM,BFP,BCM,ECW and ECW/TBW were correlated with some biochemical indexes and anthropometric indexes.3.BIA indicators such as FFM,BFP,BCM and ECW are the predictors of PEW,and other indicators such as hemoglobin,c-reactive protein,urea nitrogen,age and dialysis age are the predictors of PEW.4.Four indexes,including FFM,BFP,BCM and ECW,have a certain prediction effect on the occurrence of PEW in patients.The combined prediction effect of the four indexes is better than that of a single index.The single index in the PEW diagnostic criteria of four indexes combined with ISRNM also has a good prediction effect.5.BIA can be used to identify whether patients have the risk of PEW,which can be used as an auxiliary tool to evaluate PEW and has certain clinical application value.