Sezer Siren, Ozdemir F Nurhan, Arat Zübeyde, Perim Ozyiğit, Turan Münire, Haberal Mehmet
Başkent University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey.
Ren Fail. 2002 Jan;24(1):37-48. doi: 10.1081/jdi-120002659.
High interdialytic weight gain (IDWG) is considered as an indicator of noncompliance but could also be interpreted as an index of appetite. This study was designed to investigate the relationship IDWG with malnutrition and mortality risk in hemodialysis (HD) patients through a follow-up of 24 months. We divided HD patients into two groups according to their IDWG as Group I (IDWG < 3% of dry weight/day) (27 patients; age 46.8 +/- 21.1 years; HD duration: 28.3 +/- 39.5 months) and Group II (IDWG > or = 3% of dry weight/day) (41 patients; age 40.9 +/- 11.3 years; HD duration: 54.7 +/- 38.7 months). We investigated malnutrition through biochemical analysis (albumin, prealbumin, total cholesterol, creatinine, predialysis potassium and phosphorus levels), normalized protein catabolic rate (nPCR), anthropometric measurements. On initial assessment, group I had significantly lower predialysis creatinine, prealbumin and potassium levels than Group II (p < 0.0001, p < 0.01 and p < 0.001, respectively). At the 24th month, there were significantly lower creatinine, prealbumin, potassium and phosphorus levels in the low-IDWG group. Group I had significantly lower nPCR, body weight, body mass index and triceps skinfold thickness during the follow-up. Over the 24 months, 13 (48.1%) Group I patients and nine (21.9%) Group II patients exhibited loss of dry weight (p < 0.02). According to the survival curves prognosis was significantly poorer for Group I than Group II (2-year survival 74.0% and 92.6%, p < 0.03). Group I individuals with low albumin levels had the worst survival rate (57.1%). In conclusion there is a strong association of IDWG with nutritional parameters in HD patients. Our study draws attention for a possible risk of developing malnutrition in a HD patient with low IDWG.
透析间期体重增加（IDWG）被视为依从性差的一个指标，但也可被解释为食欲指标。本研究旨在通过24个月的随访，调查血液透析（HD）患者中IDWG与营养不良及死亡风险之间的关系。我们根据IDWG将HD患者分为两组，第一组（IDWG<干体重的3%/天）（27例患者；年龄46.8±21.1岁；HD病程：28.3±39.5个月）和第二组（IDWG≥干体重的3%/天）（41例患者；年龄40.9±11.3岁；HD病程：54.7±38.7个月）。我们通过生化分析（白蛋白、前白蛋白、总胆固醇、肌酐、透析前钾和磷水平）、标准化蛋白分解代谢率（nPCR）、人体测量学测量来调查营养不良情况。在初始评估时，第一组透析前肌酐、前白蛋白和钾水平显著低于第二组（分别为p<0.0001、p<0.01和p<0.001）。在第24个月时，低IDWG组的肌酐、前白蛋白、钾和磷水平显著降低。在随访期间，第一组的nPCR、体重、体重指数和肱三头肌皮褶厚度显著更低。在24个月期间，13例（48.1%）第一组患者和9例（21.9%）第二组患者出现干体重减轻（p<0.02）。根据生存曲线，第一组的预后明显比第二组差（2年生存率分别为74.0%和92.6%，p<0.03）。白蛋白水平低的第一组个体生存率最差（57.1%）。总之，HD患者中IDWG与营养参数之间存在密切关联。我们的研究提醒人们注意低IDWG的HD患者可能存在发生营养不良的风险。
