Relationship Between Frailty And Protein Energy Wasting In Patients With Peritoneal Dialysis

Objective:To investigate the relationship between frailty and protein energy wasting in patients with peritoneal dialysis.Methods:According to the inclusion and exclusion criteria,85 patients with peritoneal dialysis（PD）who were hospitalized and followed up in the outpatient department of nephrology of the First Hospital of Shanxi Medical University from November 2019 to November 2020were selected.The included subjects were evaluated by the Fried Scale,and according to the evaluation results,all patients were divided into two groups:patients with a score of<3 were classified as the non-frailty group,and patients with a score of 3-5 were classified as the frailty group.The general datas of the patients were collected,anthropological indicators were measured and laboratory indicators were detected.At the same time,nutritional assessment was performed by using the malnutrition-inflammation score（MIS）and serum albumin,etc.The above indicators and the incidence of the protein energy wasting（PEW）in the two groups of patients were analyzed and compared,and the correlation between the frailty of PD patients and PEW was analyzed.Results:1.Among the 85 PD patients,51 cases were in the non-frailty group（60%）,and 34cases were in the frailty group（40%）.Compared with the non-frailty group,the incidence of PEW in the frailty group was significantly increased（P<0.001）;2.The age and dialysis age of the frailty group were significantly higher than those of the non-frailty group（P<0.05）,and the urea clearance index（Kt/V）of the frailty group was significantly lower than that of the non-frailty group（P<0.05）.There was no significant difference in gender and primary disease between the two groups（P>0.05）;3.Comparison between the two groups showed that body mass index（BMI）,middle arm circumference（MAC）and middle arm muscle circumference（MAMC）in the frailty group were lower than those in the non-frailty group（P<0.001）,while there was no significant difference in triceps skin fold（TSF）between the two groups（P>0.05）;4.Comparison between the two groups showed that blood urea nitrogen（BUN）,serum creatinine（SCr）,C-reactive protein（CRP）and MIS in the frailty group were significantly higher than those in the non-frailty group,and the hemoglobin（Hb）,albumin（Alb）,prealbumin（PA）and transferrin（TRF）were significantly lower than those of the non-frailty group（P<0.05）.There were no statistically significant differences in calcium(Ca²⁺),phosphorus(P^3-),magnesium(Mg²⁺),parathyroid hormone（PTH）,total cholesterol（TC）and triglyceride（TG）between the two groups（P>0.05）;5.Spearman correlation analysis showed that frailty was positively correlated with PEW related indicators MIS（r=0.694,P<0.001）,and negatively correlated with Alb（r=-0.691,P<0.001）,PA（r=-0.410,P<0.001）,BMI（r=-0.476,P<0.001）,MAC（r=-0.635,P<0.001）,MAMC（r=-0.570,P<0.001）;6.Logistic regression analysis using frailty as dependent variable and age,dialysis age,Kt/V,BMI,MAC,MAMC,BUN,CRP,SCr,MIS,Hb,Alb,PA,TRF as independent variables showes that MIS（OR=2.304,95%CI=1.525～3.480,P<0.001）,Alb（OR=0.621,95%CI=0.510～0.757,P=0.012）,MAC（OR=0.470,95%CI=0.341-0.647,P<0.001）and MAMC（OR=0.546,95%CI=0.422-0.707,P<0.001）were the influencing factors of frailty in PD patients.Conclusion:The results suggest that early intervention of PEW in PD patients may improve the incidence of PD patients’frailty and delay the progress of poor clinical outcomes.