Li T, Wu B Y, Chen F Y, Liu K, Mao H J
Department of Nephrology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China.
Zhonghua Yi Xue Za Zhi. 2024 Jun 25;104(24):2234-2241. doi: 10.3760/cma.j.cn112137-20240113-00100.
To explore the relationship between bioelectrical impedance analysis (BIA)-derived fluid status and nutritional indicators and the prognosis in patients undergoing maintenance hemodialysis (MHD). A retrospective cohort study was conducted. The clinical data of MHD patients in Jiangsu Province Hospital between January 2014 and December 2016 were analyzed. BIA data of healthy volunteers in Gulou District, Nanjing City, collected between April and October 2022, were used to determine the cut-off value of body cell mass index (BCMI). Referring to previous research, using 0.15 as the cut-off value for the ratio of overhydration and extracellular water (OH/ECW). The data were transformed into binary variables based on these cut-off values to categorize patients into different groups. Kaplan-Meier analysis was used to plot survival curves, and the Cox proportional hazards model was performed to analyze risk factors for all-cause mortality. A total of 706 MHD patients (407 males and 299 females) were included, aged (54±15) years. MHD patients were classified into four groups based on whether BCMI was<5.4 kg/m and OH/ECW was≥0.15, which included non-overhydration and non-malnutrition group, overhydration group, malnutrition group, and overhydration and malnutrition group, with 269, 186, 151, and 100 patients, respectively. During a median follow-up of [(, )] 33 (26, 37) months, 162 patients died. Kaplan-Meier analysis showed that the median survival periods of the four groups were 52 months (95%: 41-54 months), 46 months (95%: 44-49 months), 37 months (95%: 34-40 months), and 34 months (95%: 30-38 months), respectively, with a statistically significant difference (<0.001). The 1-year survival rates were 95.5%, 93.5%, 92.1%, and 88.0% (<0.001), respectively, and the 2-year mortality rates were 92.6%, 87.1%, 83.4%, and 77.0% (<0.001), respectively. Multivariate Cox regression analysis showed that compared with non-overhydration and non-malnutrition group, the risk of all-cause mortality increased by 1.18 times in the malnutrition group (=2.18, 95%: 1.29-3.71, =0.004), and by 1.59 times in the overhydration and malnutrition group (=2.59, 95%: 1.48-4.54, =0.001). BIA-derived fluid status and nutritional indicators are associated with the prognosis of MHD patients. Compared with patients without fluid overload and malnutrition, patients with malnutrition and fluid overload have an increased risk of all-cause mortality.
探讨生物电阻抗分析（BIA）得出的液体状态与营养指标之间的关系，以及维持性血液透析（MHD）患者的预后情况。进行了一项回顾性队列研究。分析了2014年1月至2016年12月期间江苏省医院MHD患者的临床资料。使用2022年4月至10月期间收集的南京市鼓楼区健康志愿者的BIA数据来确定身体细胞质量指数（BCMI）的临界值。参考先前研究，将水过多与细胞外液比值（OH/ECW）的临界值设定为0.15。基于这些临界值将数据转换为二元变量，以便将患者分为不同组。采用Kaplan-Meier分析绘制生存曲线，并使用Cox比例风险模型分析全因死亡率的危险因素。共纳入706例MHD患者（男性407例，女性299例），年龄（54±15）岁。根据BCMI是否<5.4 kg/m²以及OH/ECW是否≥0.15，将MHD患者分为四组，分别为非水过多和非营养不良组、水过多组、营养不良组、水过多和营养不良组，患者数分别为269例、186例、151例和100例。在中位随访[(, )]33（26, 37）个月期间，162例患者死亡。Kaplan-Meier分析显示，四组的中位生存期分别为52个月（95%：41 - 54个月）、46个月（95%：44 - 49个月）、37个月（95%：34 - 40个月）和34个月（95%：30 - 38个月），差异有统计学意义（<0.001）。1年生存率分别为95.5%、93.5%、92.1%和88.0%（<0.001），2年死亡率分别为92.
