RESUMO
Objective:To investigate the nutritional status and related influential factors in older adult malnourished patients undergoing maintenance hemodialysis.Methods:A total of 150 older adult patients who received maintenance hemodialysis for over 3 months between August 2016 and June 2019 in Zhejiang Xin'an International Hospital, China were included in this study. The general data of the patients including basic information, clinical characteristics, dietary status, and accompanied diseases were collected. The nutritional status of the patients was evaluated using the Objective Score of Nutrition on Dialysis (OSND). These patients were assigned to malnutrition and normal nutrition groups according to evaluation results. Blood biochemical indexes and nutritional diet data were compared between the two groups. The factors that caused malnutrition were analyzed using logistic regression method.Results:Among the 150 patients, 72 (48.00%) patients had a normal nutritional status (normal nutrition group), and 78 (52.00%) patients had malnutrition (malnutrition group). Mild malnutrition was found in 27 (18.00%) patients, moderate malnutrition in 35 (23.33%) patients, and severe malnutrition in 16 (10.67%) patients. Body mass index, the levels of albumin, hemoglobin, and blood urea nitrogen in the malnutrition group were (19.84 ± 3.06) kg/m 2, (33.48 ± 5.61) g/L, (85.39 ± 19.06) g/L and (32.69 ± 6.80) mmol/L, respectively, which were significantly lower than those in the normal nutrition group [(22.61 ± 3.79) kg/m 2, (38.25 ± 4.78) g/L, (99.53 ± 17.8) g/L, (36.14 ± 5.02) mmol/L, t = 4.942, 5.582, 4.681, -3.511, all P < 0.05]. The levels of serum creatinine (Scr) and parathyroid hormone (PTH) in the malnutrition group were (1 094.81 ± 219.03) μmol/L and (421.93 ± 210.09) pg/mL], respectively, which were significantly higher than those in the normal nutrition group [(871.04 ± 157.63) μmol/L, (318.84 ± 207.52) pg/mL, t = -24.254, 3.020, both P < 0.05). Univariate analysis results revealed that there were significant differences in age, duration of dialysis, diabetes mellitus, nutrition knowledge, protein and energy intake between malnutrition and normal nutrition groups ( t = 9.608, 5.883, 9.423, 17.910, 26.362, all P < 0.05). Multivariate logistic regression analysis showed that age, duration of dialysis, poor nutrition knowledge and inadequate energy and protein intake were independent risk factors for malnutrition in older adult maintenance hemodialysis patients ( χ2 = 10.796, 7.818, 8.154, 5.044, all P < 0.05). Conclusion:Older adult maintenance hemodialysis patients are more prone to develop malnutrition. In addition, age, duration of dialysis, poor nutrition knowledge and inadequate energy and protein intake are independent risk factors for malnutrition. Comprehensive intervention should be carried out according to the specific situation of patients in clinical nursing.
RESUMO
Objective:To investigate the effect of different blood purification methods on inflammatory factors and nutritional status in patients with end-stage renal disease.Methods:From June 2017 to June 2019, 82 patients with end-stage renal disease were enrolled in Zhejiang Xin'an International Hospital.They were divided into group A and group B according to the random digital table method, with 41 cases in each group.High flux hemodialysis was used in group A, and routine hemodialysis was used in group B. The changes of inflammatory factors, nutritional status, renal function, parathyroid hormone(PTH) and complications before and 6 months after dialysis were compared between the two groups.Results:The levels of serum TNF-α[(153.24±20.98)ng/L], hs-CRP[(15.46±2.53)mg/L] and IL-6[(10.35±2.83)ng/L] in group A were lower than those in group B[(192.37±16.47)ng/L, (21.65±2.41)mg/L and (16.74±2.41)ng/L]( t=9.394, 11.343, 11.007, all P<0.05). The serum SF[(268.93±15.31)μg/L], ALB[(37.84±1.16)g/L] and Hb[(107.25±10.24)mg/L] in group A were higher than those in group B[(237.18±8.97)mg/L, (33.76±1.35)g/L and (95.32±7.53)mg/L]( t=11.457, 14.678, 6.010, all P<0.05). The serum creatinine[(146.71±17.37)μmol/L] and urea nitrogen[(14.37±2.18)mmol/L] in group A were lower than those in group B[(226.38±23.15)μmol/L and (20.93±2.63)mmol/L]( t=17.626, 12.296, all P<0.05). The serum PTH[(409.27±25.48)ng/L] in group A was lower than that in group B[(501.32±41.27)ng/L]( t=12.152, P<0.05). The incidence of complications in group A was lower than that in group B[12.20%(5/41) vs.39.02%(16/41), χ 2=7.746, P<0.05]. Conclusion:High flux hemodialysis is effective in the treatment of end-stage renal disease, which can reduce the micro inflammation, improve the nutritional status and reduce the complications.