The Establishment Of Individualized Overhydration Formula And Its Application In The Target Body Mass Management Of Maintenance Hemodialysis Patients

Objective fluid management and target body weight setting have always been important issues in the management of maintenance hemodialysis(MHD)patients.The purpose of this research is to(1)use body composition monitor(BCM)to explore the influence of body composition on overhydration(OH)and establish the OH calculation formula in healthy people in the region,(2)assess the feasibility of applying the formula to individualized quantification of the target body mass of MHD patients and clarify whether the formula guided target quality management was better than clinical routine management.Methods In the first stage,314 healthy subjects were selected in the physical examination center of Baotou Central Hospital.BCM was used to measure OH and other body composition,and the OH formula was established through multiple linear regression analysis.Later,49 MHD patients with stable conditions and well-controlled fluid status in the hemodialysis center of Baotou Central Hospital were selected for the verification study.The patients underwent BCM testing before hemodialysis.The actual measured OH of BCM was defined as predialysis overhydrtion(OHpre),and the value calculated by the OH formula was defined as standard overhydration(OHstd),analyzing the correlation and consistency between OHstd and OHpre.The second stage was a quasi-randomized controlled study.The intervention group guided the target body mass management according to the OH regression formula,and the control group adjusted the target body mass according to the clinical performance of the patients,and recorded the predialysis fluid status,predialysis blood pressure,use of antihypertensive drugs,dialysis complications and hospitalization of the two groups,following up for 2 months to observe the changes in indicators.Results(1)In the first stage,PhA(β=-1.266,P<0.001),LTM(β=0.987,P<0.001)and age(β=-0.307,P<0.001)were independent of OH in healthy people Influencing factors,establish the OH regression formula:OH=6.203-0.019×Y-0.083×G-0.006×F+0.098×L-1.437P(F=189.96,R~2=0.755,P<0.001),[Y:age(year);G:gender;F:fat tissue mass(kg);L:muscle tissue mass(kg);P:phase angle(°)].(2)In 49 MHD patients with stable disease and well-controlled fluid status,Pearson correlation analysis showed that the correlation coefficient between OHpre and OHstd was r=0.786(P<0.001).Bland-Altman analysis showed that the average difference between OHpre and OHstd was 0.45L,95%CI(-0.73,1.62)L.(3)In the second phase of the quasi-randomized controlled study,48 patients in the intervention group and 56patients in the control group were selected.At the end of the follow-up,there was no statistical difference between the two groups in OHpre,OHstd,total body water(TBW),extracellular water(ECW),and intracellular water(ICW)(all P>0.05).There was no significant difference in the predialysis blood pressure level and the dosage of antihypertensive drugs between the two groups.At the end of the follow-up,the proportion of the control group who did not take antihypertensive drugs increased from 25%to 32%,while that of the intervention group increased from 19%to 33%.There was no significant difference in the incidence of hypotension,cramping,and total complications of dialysis between the two groups(all P>0.05).There were 3 hospitalizations in the intervention group and 7hospitalizations in the control group.(4)Comparing the baseline index changes at the end of follow-up between the two groups,the intervention group OHpre significantly decreased by0.26±0.97 L(P=0.008),the control group OHpre decreased by 0.05±0.75 L(P=0.770);the intervention group OHstd significantly decreased 0.18±0.56 L(P=0.032),the control group OHstd decreased by 0.01±0.41 L(P=0.810);the intervention group TBW decreased by 0.65(0.20,1.58)L(P=0.001),the control group TBW decreased by 0.70(-0.40,1.38)L(P=0.002);the intervention group’s ECW decreased by 0.39±0.97 L(P=0.009),the control group’s ECW decreased by 0.23±0.77 L(P=0.033);the intervention group’s ICW decreased by 0.20(-0.20,0.70)L(P=0.007),the ICW of the control group decreased by 0.35(-0.10,0.68)L(P=0.002).During the follow-up,there was no significant difference in the changes of OHpre,OHstd,TBW,ECW,and ICW between the two groups(all P>0.05).At the end of the follow-up,the predialysis blood pressure and the dose of antihypertensive drugs in the two groups had no significant changes from baseline.Conclusion(1)OH of healthy people was independently affected by age,LTM and PhA.(2)The OH regression formula established by healthy people could be used for individualized target body mass management of MHD patients.(3)The clinical application of the formula had a positive impact on the target body quality management of MHD patients,a long-term follow-up study with a large sample size will be needed to further verify that it is superior to routine clinical management.