Zhongguo quanke yixue (Jul 2024)
Body Composition Analysis of the Effect of Water Load Parameters on Prognosis of Patients with Different Modes of Dialysis: a Multicenter Prospective Cohort Study
Abstract
Background Maintenance hemodialysis (MHD) and peritoneal dialysis (PD) are main treatment methods for uremic patients. It remains an important content of clinical research on better developing treatment protocols to address overhydration (OH) in dialysis patients, and the effect of applying body composition monitor (BCM) on the prognosis of dialysis patients treated with different dialysis models is still controversial. Objective To explore the relationship between OH parameters of BCM and prognosis in patients treated with MHD and PD. Methods From October 2017 to March 2022, 334 patients on maintenance dialysis in Beijing Jishuitan Hospital affiliated to Capital Medical Medical University, Beijing Boai Hospital, Aviation General Hospital, Beijing Changping District Hospital and Beijing Changping Hospital of Integrated Traditional Chinese and Western Medicine were included as the study objects and divided into MHD group (n=188) and PD group (n=146) according to their renal replacement therapy mode. The general data of and BCM related parameters were collected through the electronic medical record system. Patients included in the study were followed up, dialysis treatment parameters, body weight, systolic blood pressure and diastolic blood pressure were recorded, and the average of multiple follow-up results were calculated. Endpoint events were recorded during follow-up period, with the primary endpoint event as all-cause death (ACM), secondary endpoint events as cardiovascular events (CVE), combined adverse events (CAE), surgery or fracture (SOF). Spearman rank correlation analysis was used to explore the correlation between endpoint events and BCM parameters, and stepwise multiple Logistic regression analysis was used to explore the influencing factors of secondary endpoint events in patients. The ACM survival curve was plotted by Kaplan-Meier method, and the difference of survival curve between the two groups was compared by Log-rank test. Multivariate Cox regression analysis was used to explore the influencing factors of ACM. Results A total of 311 patients completed follow-up, with a median follow-up time of 29.9 (18.0, 36.0) months, including 176 patients in MHD group and 135 patients in PD group. Dialysis age, body weight, target body weight, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, and OH was lower than that in PD group (P<0.05). The mean values of body weight, target body weight, systolic blood pressure, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, while the mean value of OH, standard deviation of OH (OHsd), maximum change value of OH (OHd) and maximum change value of OH in MHD group were lower than those in the PD group (P<0.05). The incidence of CVE, CAE and SOF was 16.5% (29/176), 39.2% (69/176) and 4.0% (7/176) in the MHD group, and 45.9% (62/135), 83.0% (112/135) and 8.2% (11/135) in PD group, respectively. The incidence of CVE and CAE in MHD group was significantly lower than PD group (χ2=32.009, P<0.001; χ2=60.132, P<0.001). Multivariate Logistic regression analysis showed that the ratio of mean value of extracellular water to mean value of intracellular water in MHD group (OR=57.974, 95%CI=1.393-2 413.247) was the influencing factor of CVE, OHd (OR=1.255, 95%CI=1.076-1.462) was the influencing factor of CAE (P<0.05). The age of patients in PD group (OR=1.029, 95%CI=1.008-1.052) was the influencing factor of CVE (P<0.05), and OHd (OR=1.962, 95%CI=1.355-2.842) was the influencing factor of CAE (P<0.05). Kaplan-Meier survival curve of ACM between the two groups showed that the incidence of ACM in PD group was higher than that in MHD group (χ2=7.145, P=0.008). Multivariate Cox regression analysis showed that age (HR=1.070, 95%CI=1.019-1.123) was the influencing factor of ACM in MHD group (P<0.05), DBPm (HR=0.942, 95%CI=0.854-0.992) and OHsd (HR=3.612, 95%CI=2.072-6.296) were the influencing factors of ACM in PD group (P<0.05) . Conclusion The incidence of primary endpoint event and secondary endpoint events in PD group was higher than that in MHD patients, and OH was more obvious in PD patients than MHD patients. The fluctuation of OH value obtained by BCM could predict ACM in PD patients.
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