European Renal Nutrition Working Group, European Renal Association-European Dialysis Transplant Association, London, United Kingdom.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Nephrol Dial Transplant. 2021 Jan 25;36(2):346-354. doi: 10.1093/ndt/gfaa253.
It has been a long-standing clinical concern that haemodialysis (HD) patients on afternoon shifts (ASs) are more prone to protein-energy wasting (PEW) than those on morning shifts (MSs), as their dialysis scheme and post-dialysis symptoms may interfere with meal intake. We evaluated the effect of time of day of HD on the evolution of body composition changes and PEW surrogates.
We conducted a retrospective study among 9.963 incident HD patients treated in NephroCare centres (2011-16); data were routinely collected in the European Clinical Database. The course of multi-frequency bioimpedance determined lean and fat tissue indices (LTI and FTI) between patients in MSs/ASs over 2 years were compared with linear mixed models. Secondary PEW indicators were body mass index, albumin, creatinine index and normalized protein catabolic rate. Models included fixed (age, sex, vascular access and diabetes mellitus) and random effects (country and patient).
Mean baseline LTI and FTI were comparable between MSs (LTI: 12.5 ± 2.9 kg/m2 and FTI: 13.7 ± 6.0 kg/m2) and ASs (LTI: 12.4 ± 2.9 kg/m2 and FTI: 13.2 ± 6.1 kg/m2). During follow-up, LTI decreased and FTI increased similarly, with a mean absolute change (baseline to 24 months) of -0.3 kg/m2 for LTI and +1.0 kg/m2 for FTI. The course of these malnutrition indicators did not differ between dialysis shifts (P for interaction ≥0.10). We also did not observe differences between groups for secondary PEW indicators.
This study suggests that a dialysis shift in the morning or in the afternoon does not impact the long-term nutritional status of HD patients. Regardless of time of day of HD, patients progressively lose muscle mass and increase body fat.
长期以来，临床医生一直关注到下午班（AS）的血液透析（HD）患者比早上班（MS）的患者更容易出现蛋白质能量消耗（PEW），因为他们的透析方案和透析后症状可能会影响进食。我们评估了 HD 时间对身体成分变化和 PEW 替代指标演变的影响。
我们对在 NephroCare 中心接受治疗的 9963 例新发生的 HD 患者（2011-16 年）进行了回顾性研究；数据常规收集于欧洲临床数据库。通过线性混合模型比较了 MSs/ASs 患者在 2 年内多频生物阻抗测定的瘦组织和脂肪组织指数（LTI 和 FTI）的变化。次要的 PEW 指标包括体重指数、白蛋白、肌酐指数和正常化蛋白分解率。模型包括固定（年龄、性别、血管通路和糖尿病）和随机效应（国家和患者）。
MSs（LTI：12.5±2.9kg/m2和FTI：13.7±6.0kg/m2）和 ASs（LTI：12.4±2.9kg/m2和FTI：13.2±6.1kg/m2）的患者平均基线 LTI 和 FTI 相似。在随访期间，LTI 下降，FTI 增加，LTI 的平均绝对变化（基线至 24 个月）为-0.3kg/m2，FTI 的平均绝对变化为+1.0kg/m2。这些营养不良指标的变化在透析班次之间没有差异（P 交互作用≥0.10）。我们也没有观察到两组之间次要 PEW 指标的差异。
本研究表明，上午或下午的透析班次不会影响 HD 患者的长期营养状况。无论 HD 的时间如何，患者的肌肉量逐渐减少，体脂肪增加。
