Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China.
Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China,
Blood Purif. 2020;49(3):334-340. doi: 10.1159/000504245. Epub 2020 Feb 19.
BACKGROUND/AIM: The relationship between body mass index (BMI) and intradialytic hypotension (IDH) has been inconsistently reported, but no further research has investigated the correlation between body composition and IDH so far. This study aimed to determine whether the lean tissue index (LTI), fat tissue index (FTI), or both derived from body composition monitoring (BCM) is associated with IDH defined as a nadir intradialytic systolic blood pressure of <90 mm Hg and ≥3 episodes hypotension per 10 hemodialysis (HD) treatments in patients undergoing prevalent HD.
The observational cohort study comprised 1,463 patients receiving thrice-weekly HD from 13 dialysis centers. LTI and FTI were assessed using a BCM machine, a multifrequency bioimpedance spectroscopy device. Unadjusted and multivariable adjusted logistic regression models were fit to estimate the association of body composition with the odds of developing IDH.
One hundred and seven patients (7.3%) were diagnosed as IDH. The difference in dialysis vintage, BMI, FTI, LTI, high-density lipoprotein cholesterol, and C-reactive protein between IDH and non-IDH groups was statistically significant (all p < 0.05). The prevalence of diabetes among IDH patients was slightly higher than among non-IDH patients. In logistic regression models, low LTI and high FTI, but not high BMI were associated with greater odds of IDH ("high" as above median and "low" as below median). When patients were further stratified into 4 distinct body composition groups based on both the LTI and FTI, only the low LTI/high FTI group was connected with a significantly higher odds of IDH (OR 2.686, 95% CI 1.072-6.734; reference: low LTI/low FTI group).
The LTI and FTI can provide better correlation of IDH occurrence than the BMI alone in prevalent HD patients. The low LTI/high FTI appears to be most associated with IDH. An optimal body composition for preventing the occurrence of IDH needs to be determined.
背景/目的：体重指数（BMI）与透析中低血压（IDH）之间的关系尚未得到一致报道，但迄今为止尚无进一步的研究调查身体成分与 IDH 之间的相关性。本研究旨在确定从身体成分监测（BCM）得出的瘦组织指数（LTI）、脂肪组织指数（FTI）或两者是否与 IDH 相关，IDH 定义为接受常规血液透析（HD）治疗的患者中透析时收缩压最低值<90mmHg 且每 10 次 HD 治疗中≥3 次低血压。
这项观察性队列研究纳入了来自 13 个透析中心的 1463 名接受每周三次 HD 治疗的患者。使用 BCM 机（一种多频生物阻抗光谱设备）评估 LTI 和 FTI。使用未调整和多变量调整的逻辑回归模型来估计身体成分与发生 IDH 的几率之间的关联。
107 名患者（7.3%）被诊断为 IDH。IDH 组和非 IDH 组在透析龄、BMI、FTI、LTI、高密度脂蛋白胆固醇和 C 反应蛋白方面存在统计学差异（均 p<0.05）。IDH 患者的糖尿病患病率略高于非 IDH 患者。在逻辑回归模型中，低 LTI 和高 FTI，但不是高 BMI，与 IDH 的发生几率更高相关（“高”是指高于中位数，“低”是指低于中位数）。当根据 LTI 和 FTI 将患者进一步分为 4 个不同的身体成分组时，只有低 LTI/高 FTI 组与 IDH 的发生几率显著增加相关（OR 2.686，95%CI 1.072-6.734；参考：低 LTI/低 FTI 组）。
在接受常规 HD 治疗的患者中，LTI 和 FTI 比 BMI 单独提供了与 IDH 发生更好的相关性。低 LTI/高 FTI 似乎与 IDH 关系最密切。需要确定预防 IDH 发生的最佳身体成分。
