摘要
目的探讨应用生物电阻抗技术测定透析后容量负荷过重(细胞外液与总体液比值升高)对维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡的预测作用。方法入选北京大学人民医院肾内科临床无显性水肿的MHD患者,应用赛康mBCA515生物电阻抗分析仪测量患者透析后总体液(total body water,TBW)、细胞外液(extracellular water,ECW)和细胞内液(intracellular water,ICW)、肌肉及脂肪质量等,记录患者一般资料、血压、化验、超声心动等数据,定义ECW/TBW%>正常上限为透析后容量负荷过重(over hydration,OH),进行随访,观察终点为全因死亡。以全因死亡为因变量,透析后OH为研究自变量,单因素分析有统计学差异和既往研究中存在临床意义的变量作为校正变量,共同纳入多因素COX回归分析,探讨MHD透析后OH对全因死亡的预测作用。结果①入选119例MHD患者,随访4年,随访期间肾移植2例,最终入组117例(男/女:73/44),年龄(58±15)岁,透析龄中位数67(39,120)月。随访结束时死亡21例(17.9%)。②多因素COX回归分析提示:经年龄、透析龄等多因素校正后,透析后OH(HR=17.459,95%CI:2.801~108.832,P=0.002)是MHD患者全因死亡的独立危险因素。结论透析后细胞外液与总体液比值可敏感识别无显性水肿的MHD患者容量状态,透析后容量负荷较重是维持性血液透析患者全因死亡的独立危险因素,需给予患者容量管理更多关注。
Objective To explore the role of post-dialytic overhydration(OH)determined by bioelectrical impedance technique in the prediction of all-cause death in maintenance hemodialysis(MHD)patients.Methods A total of 117 MHD patients without edema from Peking University People's Hospital were recruited for the observation.Their total body water(TBW),extracellular water(ECW),intracellular water(ICW),fat mass and muscle mass after dialysis were measured by bioelectrical impedance analyzer.The ECW/TBW ratio higher than that of normal upper limit after hemodialysis was defined as post-dialytic OH.Blood pressure,laboratory tests and echocardiography were recorded.The primary endpoint was all-cause death in the follow-up period of 4 years.Multivariate COX regression analysis was conducted to explore the predictive effect of post-dialytic OH on all-cause death in MHD patients using all-cause death as the dependent variable,post-dialytic OH as the independent variable,and statistically significant variables in univariate analysis and clinically significant variables in previous studies as the correction variables.Results①A total of 117 patients(73 males and 44 females,average age 58±15 years old)on MHD for 67(39,120)months were included in this study.They were followed up for 4 years,and 21 cases died(17.9%)and 96 cases survived in the follow-up period.②Multivariate COX regression analysis showed that post-dialytic OH was an independent risk factor for all-cause death(HR=17.459,95%CI 2.801~108.832,P=0.002)in MHD patients after adjusting for a variety of factors.Conclusions Post-dialytic ECW/TBW ratio was a sensitive biomarker of volume status in MHD patients without evident edema.Post-dialytic OH was an independent risk factors for all-cause death in MHD patients.Therefore,volume management should be carefully conducted in MHD patients.
作者
朱丽
杨冰
蔡美顺
赵新菊
王琰
倪梦凡
赵玉超
甘良英
左力
ZHU Li;YANG Bing;CAI Mei-shun;ZHAO Xin-ju;WANG Yan;NI Meng-fan;ZHAO Yu-chao;GAN Liang-ying;ZUO Li(Department of Nephrology,Peking University People's Hospital,Beijing 100044,China)
出处
《中国血液净化》
CSCD
2022年第3期166-170,共5页
Chinese Journal of Blood Purification
基金
北京市科学技术委员会首都临床特色应用研究支持项目(Z131107002213122)。
