Analysis of risk factors associated with protein-energy wasting in elderly hemodialysis and peritoneal dialysis patients / 中华老年医学杂志

ABSTRACT

Objective:To analyze the risk factors for protein-energy wasting(PEW)in elderly patients undergoing hemodialysis(HD)and peritoneal dialysis(PD), in order to provide evidence for the prevention of PEW and improve the prognosis in these patients.Methods:According to the diagnostic criteria for PEW proposed by the International Society for Renal Nutrition and Metabolism, 112 elderly patients who had undergone PD and HD without PEW from May 2016 to June 2020 in the renal medicine department of the Eighth People's Hospital of Shanghai, the geriatric medicine department of Zhongshan Hospital Affiliated to Fudan University and the renal medicine department of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were included as the non-PEW group.During the same period, 114 cases with PEW were recruited as the PEW group.Differences in general patient data, biochemical test values, anthropometric measurements, bioelectrical impedance and other index values were compared between the two groups.Independent risk factors for PEW in elderly HD and PD patients were analyzed by using binary Logistic regression analysis.Results:Compared with the non-PEW group, the PEW group had a higher mean age( t=0.951, P<0.001), a higher proportion of patients aged ≥65 years( χ2=17.161, P<0.001), a lower body mass index( t=6.740, P<0.001), a higher incidence of diabetic nephropathy( χ2=14.176, P<0.001), a higher hemodialysis rate( χ2=4.543, P=0.033), and a longer duration(months)of dialysis( t=2.306, P=0.023). Levels of serum transferrin, prealbumin, total protein, hemoglobin and total cholesterol and body cell mass index were lower( t=6.262, 13.405, 9.507, 8.341, 4.610, 5.599 and 2.499, all P<0.05), high-sensitivity C-reactive protein levels and the body water percentage were higher( t=6.380, 4.519, both P<0.001), and the upper arm muscle circumference was smaller( t=5.418, P=0.000)in the PEW group than in the non-PEW group.Binary Logistic regression analysis showed that age≥65 years, dialysis duration, serum albumin and high-sensitivity C-reactive protein levels were independent influencing factors for PEW in elderly HD patients( OR=2.762, 0.182, 2.694 and 2.980, P=0.023, 0.007, 0.009 and 0.027). Age ≥65 years, body mass index and the hemoglobin level were independent influencing factors for PEW in elderly PD patients( OR=2.452, 0.671 and 0.962, P=0.013, 0.000 and 0.000). Conclusions:The incidence of PEW is lower in elderly HD patients than in elderly PD patients.Clinical intervention should be carried out based on influencing factors, in order to prevent the occurrence of PEW.