Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Ren Fail. 2022 Dec;44(1):1192-1200. doi: 10.1080/0886022X.2022.2095287.
It is becoming increasingly evident that the accurate assessment of fluid status is critical to ensure optimal care in patients undergoing hemodialysis (HD). Various fluid parameters, including overhydration (OH) and overhydration/extracellular water (OH/ECW%), which can be obtained using a bioimpedance spectroscopy device have been used to indicate the hydration status in such patients. This study aimed to explore the effect of these fluid parameters on cardiovascular events and determine which parameter was a better predictor of cardiovascular events (CVEs).
A total of 227 patients who underwent HD at the Hangzhou Hospital of Traditional Chinese Medicine were enrolled in this prospective study between December 2017 and August 2018. Clinical data were collected, and the fluid status of patients was assessed using a body composition monitor. The patients were followed up until December 2020. The primary outcomes were CVEs. The association between fluid parameters and CVEs was analyzed using Cox proportional hazards models. The areas under the curve (AUCs) of receiver operating characteristic analysis and improvement in the global chi-squared value were used to compare the predictive values of fluid parameters for CVEs.
During a median follow-up of 31 months, 66 CVEs were recorded. The patients with a higher absolute hydration index (OH) and a relative hydration index (OH/ECW%) exhibited an increased risk of developing CVEs. After adjusting for confounding factors, both OH [hazard ratio (HR) 1.279 per L, 95% confidence interval (CI) 1.047-1.562; 0.016] and OH/ECW% (HR 1.061 per %, 95% CI 1.017-1.108; 0.006) were independently associated with CVEs. The predictive ability of the absolute hydration index was superior to the relative hydration index based on AUC calculations for CVEs. Furthermore, a greater change in in predicting CVEs was noted for the absolute hydration index.
Both absolute hydration index and relative hydration index were found to be independent predictors of CVEs in univariate and multivariate analyses. Furthermore, the absolute hydration index had a better additive predictive value than the relative hydration index in predicting CVEs.
越来越明显的是，准确评估液体状态对于确保接受血液透析（HD）治疗的患者得到最佳护理至关重要。各种液体参数，包括通过生物阻抗谱设备获得的超水量（OH）和超水量/细胞外液百分比（OH/ECW%），已被用于指示此类患者的水合状态。本研究旨在探讨这些液体参数对心血管事件的影响，并确定哪个参数是心血管事件（CVE）更好的预测指标。
本前瞻性研究共纳入 2017 年 12 月至 2018 年 8 月在杭州市中医院接受 HD 的 227 例患者。收集临床数据，并使用身体成分监测仪评估患者的液体状态。对患者进行随访至 2020 年 12 月。主要结局为 CVE。使用 Cox 比例风险模型分析液体参数与 CVE 之间的关系。使用接受者操作特征曲线（ROC）下面积（AUC）和整体卡方值的改善来比较液体参数对 CVE 的预测价值。
在中位随访 31 个月期间，记录到 66 例 CVE。绝对水化指数（OH）和相对水化指数（OH/ECW%）较高的患者发生 CVE 的风险增加。在校正混杂因素后，OH [风险比（HR）每升 1.279，95%置信区间（CI）1.047-1.562；P=0.016]和 OH/ECW%（HR 每增加 1%，95%CI 1.017-1.108；P=0.006）均与 CVE 独立相关。基于 AUC 计算，绝对水化指数对 CVE 的预测能力优于相对水化指数。此外，绝对水化指数的变化对预测 CVE 的作用更大。
在单变量和多变量分析中，绝对水化指数和相对水化指数均被发现是 CVE 的独立预测指标。此外，绝对水化指数在预测 CVE 方面的附加预测价值优于相对水化指数。
