A multi-center clinical study on the relationship between dry weight and protein energy wasting in patients with maintenance hemodialysis / 中国实用内科杂志

ABSTRACT

OBJECTIVE: To explore the relationship between dry weight setting and the related parameters of PEW of multicenter hemodialysis patients in Guizhou. in order to provide the basis for setting dry weight in patients. METHODS: We conducted the research in patients of 11 hemodialysis center in Guizhou province. We collected demographic data(age, gender, nationality, marital status, education level, income status and so on) by questionnaire; are collected dry weight, ECW, ICW, fat mass,lean body mass and so on by bioelectrical impedance analysis, and then we also collected physical measurement indexes, such as waist circumference, hip circumference, medium arm circumference(MAC), tricep fold thickness(TSF)and crus diameter. The data is divided into three groups according to the dry weight setings. Group 1 dry weight setting was slightly lower(dry weight setted by doctors was slightly lower than bioelectrical impedance analysis results,withen 1 kg); group 2 dry weight setting was normal; group 3 dry weight setting slightly higher group(dry weight setted by doctors was slightly higher than bioelectrical impedance analysis results,withen 1 kg). We used Chi-square analysis to analyze PEW prevalence, compared differences of the PEW indications by variance analysis, and then we used Spearman correlation analysis to analyze the correlation between PEW and the indications. Influence of various factors on the PEW was analyzed by logistic regression analysis. RESULTS: The PEW morbidity of group 3 was higher than the other two groups. PEW indicators such as upper arm midpoint diameter, tricep fold thickness, hip circumference, fat mass, BMI, Hb, Alb and prealbumin were lower than the other two groups, the difference being statistically significant(P<0.05). Correlation analysis results show that the degree of the factors associated with the PEW was as follows in turn BMI(r=-0.677, P<0.05), dry weight(r=0.636, P<0.05), upper arm midpoint diameter(r=-0.589, P<0.05), albumin(r=-0.562, P<0.05) and hip circumference(r=-0.475, P<0.05). Logistic regression showed that the factors affecting PEW were albumin(OR = 0.883, 95%CI 0.782-0.997, P<0.05), BMI(OR = 0.671, 95%CI 0.509-0.884, P<0.05), upper arm midpoint diameter(OR = 0.457, 95% CI 0.318-0.655, P<0.05) and dry weight(OR = 1.191, 95%CI 1.041-1.363, P<0.05). CONCLUSION: The dry weight setting too high, insufficient amount of ultrafiltration and inadequate dialysis can increase the occurrence of PEW.