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Objective:To investigate the impact of sarcopenia on mortality in maintenance hemodialysis (MHD) patients.Methods:It was a retrospective cohort study. MHD patients admitted to the blood purification center of Guangzhou Red Cross Hospital in March 2021 were recruited. Demographic data and laboratory indicators, grip strength, and bioelectrical impedance analysis indexes were collected. The patients were divided into sarcopenia group and non-sarcopenia group based on whether they had sarcopenia or not. By following up for 18 months, the survival status of the patients was documented. Kaplan-Meier method, multivariate Cox regression model, and Fine-Gray competing risk model were used to assess the relationship between sarcopenia and all-cause mortality, cardio-cerebrovascular disease mortality, and infection-related disease mortality.Results:A total of 143 MHD patients were enrolled in this study, with age of 65 (58,74) years old and 89 males (62.24%). The prevalence of sarcopenia was 25.17% (36/143). The sarcopenia group had older age ( Z=3.486, P<0.001), higher single-pool Kt/V ( Z=3.634, P<0.001), interleukin-6 ( Z=3.434, P<0.001) and extracellular water/intracellular water ratio ( Z=2.477, P=0.013), and lower body mass index ( Z=-3.210, P=0.001), serum phosphorus ( t=2.475, P=0.015), serum creatinine ( t=3.319, P=0.001), serum albumin ( t=2.851, P=0.005), serum prealbumin ( t=3.384, P<0.001), extracellular water ( Z=-5.124, P<0.001), intracellular water ( Z=-5.417, P<0.001), grip strength ( Z=-3.796, P<0.001) and appendicular skeletal muscle mass index ( t=3.862, P<0.001) than those in the non-sarcopenia group. Kaplan-Meier survival curves showed that the overall survival rate in the sarcopenia group was lower than that in the non-sarcopenia group (Log-rank test χ2=15.99, P<0.001). Multivariable Cox regression analysis demonstrated that sarcopenia was independently correlated with all-cause mortality in MHD patients after adjusting for confounding factors ( HR=2.75, 95% CI 1.07-7.10, P=0.036). Fine-Gray competing risk model result showed that there was no statistically significant difference in cardio-cerebrovascular disease mortality between sarcopenia group and non-sarcopenia group ( SHR=4.99, 95% CI 0.94-26.85, P=0.069); the risk of infection-related disease mortality in sarcopenia group was 5.76 folds than that in non-sarcopenia group ( SHR=5.76, 95% CI 1.15-28.96, P=0.034). Conclusions:There is prevalent sarcopenia in MHD patients. Moreover, sarcopenia is an independent risk factor of all-cause mortality and infection-related disease mortality in MHD patients.
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Objective:To compare the therapeutic effect of polysaccharide iron complex capsule and Shengxuening tablet on renal anemia in maintenance hemodialysis (MHD) patients.Methods:Patients who received MHD treatment from April to June 2016 in our dialysis center and met the criteria for iron deficiency anemia were block-randomly divided into two groups: the polysaccharide-iron complex group and the Shengxuening group. Blood routine, iron metabolism biomarkers and biochemical exams were measured before treatment and at the 1st, 2nd and 3rd months after treatment, and the incidence of adverse reactions were recorded. The compliance rate of the two groups was observed and compared, and the block-randomized-statistical methods were used to compare the clinical data of the two groups before and after treatment, and cost-benefit analysis was also conducted.Results:Thirty patients in each group completed follow-up. After three months of treatment, the blood routine and iron metabolism indicators of the two groups were improved. Compared with the Shengxuening group, the polysaccharide iron complex group had higher therapeutic efficiency, and the levels of hemoglobin, transferrin saturation and serum ferritin were higher, and lower use of recombinant human erythropoietin ( P<0.05). The other indexes such as red blood cell (RBC), hematocrit (HCT) levels and the effective rate of anemia correction, the effective rate of iron therapy, the effective rate of iron therapy between the two groups were similar. Cost-benefit analysis suggested that the use of polysaccharide iron complexes to treat anemia has lower costs and higher benefits ( P<0.05). Conclusions:Polysaccharide iron complex capsule can better correct anemia and improve iron metabolism, and has low cost-effectiveness, which can effectively reduce medical insurance expenditure. It is a good iron supplementing method in addition to intravenous iron supplement.
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Objective:To compare three nutritional screening tools in predicting dialysis-related pro tein-energy wasting(PEW) among maintenance hemodialysis(MHD) patients and to find a more rapid,accurate,and feasible screening tool.Methods:The nutrtional risk screening 62002 (NRS 2002),7-point subjective global assessment(SGA) and malnutrition inflammation scores (MIS) were compared among 205 MHD patients.Correlations between the serum biochemistry,anthropometry and different screening tools were analyzed,and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.Results:A total of 31.2％ of HD patients had PEW by ISRNM criteria,whilst using NRS 2002,7-point SGA and MIS,58％,40.8％ and 46.8％ of MHD patients exhibited PEW respectively.The results of three screening tools were closely related to those by serum biochemistry and anthropometry (P ＜ 0.05),but the composite correlation coefficient between the screening tools for PEW and the objective nutritional index commonly used was higher in NRS 2002(r =0.787,P ＜ 0.001) than in 7-Point SGA or MIS.NRS 2002 had higher sensitivity and accuracy values (87.5％ and 59.1％,respectively) in MHD Patients.Conclusion:MIS,7-PointSGA and NRS 2002 are valid tools for nutrition screening of dialysis patients,and NRS 2002 may be the best one.
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Objective To evaluate the use of bioelectrical impedance phase angle (PhA) for predicting protein-energy wasting (PEW) in hemodialysis patients.Methods This cross-sectional study involved 144 patients who were on maintenance hemodialysis (MHD) in the blood purification centers of two tertiary hospitals in Guangzhou,where the body impedance analysis (BIA) was performed after the hemodialysis procedure and the prevalence of protein-energy wasting (PEW) was investigated by the 7-point subjective global assessment (SGA) among.Nutritional indices of the patients with PEW were compared with the well-nourished patients to identify independent variables that can predict PEW and determine the cut-off value of PhA as a predictor.Results The patients with PEW had significantly lower PhA values than the Non-PEWpatients (t =8.68,P=0.00).PhA was positively related with the nutritional indices reflecting function of body proteins or muscles,such as serum albumin (rs=0.25,P=0.00),prealbumin (rs=0.31,P=0.00),free fat mass index (rs=0.25,P=0.00),and mid-arm muscle circumference (rs =O.44,P =O.00).However,the correlations of PhA with fat mass (rs =0.04,P=0.66) and body fat percentage (rs =-0.04,P=0.66) were no statistical significance.Multivariate logistic regression analysis revealed that PhA (OR =4.48,P =0.00) and body mass index (OR =1.59,P =0.00) were independent predictors of PEW,but PhA was more potent than BMI.Receiver operating characteristic curve analysis suggested that the optimum PhA cut-off point for predicting PEW was 4.6.Conclusion PhA can be a useful independent predictor for PEW in hemodialysis patients and its cut-off value is 4.6.
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To survey the serum uric acid (SUA) levels and associated risk factors of hyperuricemia among youth and middle-aged residents in Guangzhou.A total of 1420 subjects,aged from 20 to 60 years,receiving health check-up at our hospital in 2010 were enrolled.The total prevalence of hyperuricemia was 22.04％,32.01％ in males and 14.07％ in females.The average SUA was (388 ±78) μmol/L in males and (288 ± 63) μ mol/L in females.The prevalence of hyperuricemia in males was 30.11％ before 40 years of age and 33.81％ between 40 and 60 years of age.The average level of SUA in males was significantly higher than that of females.logistic regression analysis showed that BUN,body mass index (BMI) and hypertriglyceridemia were the independent risk factors of disease while HDL-C and gender (females) the protective factors.
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Objective To observe the effect of angiotensin-converting enzyme inhibitors (ACEI) on anemia and erythropoietin (EPO) requirements in maintenance hemodialysis patients. Methods Ninety maintenance hemodialysis patients with hypertension and anemia were divided into 2 groups by random digits table, observation group (45 cases, using ACEI as antihypertensive treatment), control group [45 cases,using calcium channel blocker (CCB) as antihypertensive treatment]. The follow-up period after starting ACEI or CCB therapy was one year. The hemoglobin concentration, serum EPO, EPO requirements were compared after 0, 2, 4, 6, 8, 10, 12 months' treatment. Results In response to ACEI, the mean hemoglobin value in observation group decreased progressively, reaching statistical significance after 6 months, and it had significant difference compared with that in control group [6 months: (94.21±9.20) g/Lvs. (105.55±9.16) g/L,12 months: (95.90±6.75) g/L vs. (105.81±4.45) g/L,P <0.05]. The EPO requirements experienced a progressive increase in observation group and reached statistical significance after 8 months, compared with those in control group [8 months: ( 10 090.75±1918.35) U/week vs. (7010.32±1600.15) U/week, 12 months: (11 586.39±2009.76) U/week vs. (7068.48±1615.35) U/week,P<0.05].Serum erythropoietin concentration remained stable during the study in two groups. Conclusion ACEI can worsen anemia and reduce the efficacy of EPO in maintenance hemodialysis patients.
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Objective To investigated the effects of long term use of very low protein diet(VLPD,0 3 g?kg-1?d-1) treatment on patients with chronic renal insufficiency without essential amino acids(EAAs) or related ketoacids supplement.Methods Thirty seven patients with established severe chronic renal failure (CRF)[Scr(588 2?123 5)?mol/L, Ccr(9 77?3 48)ml?min-1?(1 73m2)-1]were divided into 2 groups according to their actual protein intake: 20 patients with protein intake of (0 33?0 04)g?kg-1?d-1 were used as VLPD group, while other 17 CRF patients whose protein intake was 0 6 g?kg-1?d-1 were served as low protein diet group (LPD). Results All patients in VLPD group showed good compliance to this very low protein diet,and no one presented signs of protein malnutrition during the observation. The concentrations of serum albumin and transferrin were maintained in normal ranges during the follow up period despite the transferrin levels in both groups gradually decreased as time went on. The serum concentration of transferrin was higher in VLPD patients than that in LPD patients at the end of study (P