Chinese Maintenance Hemodialysis Patients Research Articles

MON-142 Cross-sectional study of nutritional status in Chinese maintenance hemodialysis patients

Protein-energy malnutrition are common in maintenance hemodialysis (MHD) patients and are associated with increased morbidity and mortality. To evaluate the nutritional status of Chinese MHD patients, we performed a cross-sectional study in unselected patients treated with hemodialysis thrice weekly. The subjects were MHD patients in our outpatient hemodialysis center. The physical measurement, laboratory values and three-day food diaries were collected. Body composition was measured by bioelectrical impedance analysis (BIA). Global nutritional status was evaluated by the modified quantitative subjective global assessment (MQSGA). 159 MHD patients (males 83, females 76, mean age 64.09±13.55 years, mean dialysis age 46.83±53.65 months) were enrolled. The mean body mass index (BMI) was 21.42±3.01kg/m2 in men and 20.35±2.73kg/m2 in women. The upper arm muscle circumference (23.72±2.75cm in men, 22.52±2.78cm in women) and hand-grip strength (26.23±9.61 in men, 17.16±7.76 in women) were lower than normal population standard values. By using BIA, the body fat mass percent (17.89±7.98 in men, 24.06±6.90 in women) was within the standard range of the normal population, but the body muscle mass percent (77.71±8.51 in men, 71.17±7.36 in women) was lower than the standard range of the normal population. Both the calorie intake (27.66±11.99kcal/kg) and protein intake (1.11±0.42g/kg) were lower than the K/DOQI guideline recommendation. The dietary sodium intake (2935.75±1495.50mg) was higher than K/DOQI guideline recommendation and the dietary phosphorus intake (903.25±300.38mg) was within the range of the K/DOQI guideline recommendation. The mean levels of serum albumin, serum phosphate and serum calcium were 39.34±3.12g/l, 1.76±0.62mmol/l and 2.35±0.26mmol/l, respectively. The mean level of MQSGA was 11.34±2.43. The total nutritional status of MHD patients in our hemodialysis center were not bad, except for body muscle mass and hand-grip strength. Despite the lower dietary calorie and protein intake, the nutritional status and normal serum phosphate level were maintained, which suggested the amount of dietary calorie and protein intake for Chinese MHD patients needs to be further investigated.

Comparison of visceral, general and central obesity indices in the prediction of metabolic syndrome in maintenance hemodialysis patients.

We aimed to compare the predictive ability of the anthropometric indices reflecting general, central and visceral obesity for identification of metabolic syndrome (MetS) in maintenance hemodialysis (MHD) patients. A multicenter, cross-sectional study that consisted of 1603 adult MHD patients (54.6 ± 16years) was conducted in Guizhou Province, Southwest China. Eight anthropometric obesity indexes including body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), conicity index (Ci) and visceral adiposity index (VAI), lipid accumulation product (LAP), a body shape index (ABSI) and body roundness index (BRI) were recorded. MetS was defined based on the criteria of the International Diabetes Federation. Participants were categorized into four groups according to quartiles of different obesity indices. Binary logistic regression analyses were used to evaluate the associations between the eight obesity parameters and MetS. Receiver operator curve (ROC) analyses were used to identify the best predictor of MetS. The eight anthropometric obesity indexes were independently associated with MetS risk, even after adjustment for age, sex, educational status and history of smoking. The ROC analysis revealed that all the eight obesity indices included in the study were able to discriminate MetS [all area under the ROC curves (AUCs) > 0.6, P < 0.05]. LAP showed the highest AUC and according to the maximum Youden indexes, the cut off values for men and women were 27.29 and 36.45, respectively. The AUCs of LAP, VAI, ABSI, BRI, WC, WHtR, Ci and BMI were 0.88, 0.87, 0.60, 0.78, 0.79, 0.78, 0.69 and 0.76 for men, and 0.87, 0.85, 0.65, 0.79, 0.81, 0.79, 0.73 and 0.76 for women, respectively. There was no significant difference in the AUC value between LAP and VAI, BRI/WHtR and BMI in men and between BRI/WHtR and BMI in women. The AUC value for WHtR was equal to that for BRI in identifying MetS. Visceral obesity marker LAP followed by VAI was the most effective predictor of MetS while ABSI followed by CI was the weakest indicator for the screening of MetS in MHD patients. BRI could be an alternative obesity measure to WHtR in assessment of MetS. LAP may be a simple and useful screening tool to identify individuals at high risk of MetS particularly in middle-aged and elderly Chinese MHD patients. Level V, descriptive study.

Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: a multi-center cross-sectional study

Backgroud Fatigue is considered as a common symptom in patients with end-stage renal disease (ESRD) and can significantly decrease patients’ quality of life. This study aimed to assess fatigue in hemodialysis patients and to investigate risk factors of fatigue in Chinese patients receiving maintenance hemodialysis (MHD) in China. Methods Eligible patients completed questionnaires including demographic information, a Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), the Family APGAR Index (APGAR), the medical outcomes study health status-Social Functioning subscale (SF-36,SocF), and the Pittsburgh sleep quality index (PSQI). Laboratory parameters were abstracted by medical records review. The multiple linear regression model was used to relate parameters with the FACIT-Fatigue score. Results A total of 345 MHD patients (216 men and 129 women, age 55.6 ± 12.8) were recruited in this study. The score of FACIT-Fatigue was 39 (Interquartile Range, 31-44). Fatigue was correlated with PSQI scores (p < 0.001), SocF scores (p < 0.001), comorbidity (p = 0.006), exercise time <1 hour per day (p = 0.003), adequacy of dialysis (Kt/V) < 1.2 (p = 0.016), APGAR scores (p = 0.014), and high Scr (p = 0.043). Conclusions Fatigue is related to sleep disturbance, social and family functioning, taking physical exercise time, comorbidity condition, Kt/V and serum creatinine level in Chinese MHD patients. Future studies and interventions should focus on developing strategies and improving the quality of life in patients by addressing these significant contributing factors.

Dietary protein intake less than 1.2 g/kg/day benefits chinese maintenance hemodialysis patients

The K/DOQI guidelines recommend that MHD patients have a dietary protein intake (DPI) of at least 1.2 g/ kg/day to avoid malnutrition. It is hard for most Chinese MHD patients to meet the criteria. To know the nutritional status and metabolic results of different DPI in our patients is necessary. Part 1: Cross–sectional study: 189 MHD patients using low-flux dialyzers were enrolled in April 2009 in our center. Three-day-dietary diaries were analyzed by dietitians. Serum cholesterol, albumin, calcium and phosphate and CO2CP (carbon dioxide combining power) were examined. The nPCR was used to assess the accuracy of DPI. Part 2: Pilot study: A two–year, non-randomized controlled trial was carried out. The inclusion criteria were (1) MHD>3 years and Kt/V>1.2; (2) no residual renal function; (3) Serum albumin>35 g/l; (4) CRP<3.25 mmol/l; (5) Hemoglobin >90 g/l. Two groups were set: DPI>1.2 g/ kg/day ( NP group) and DPI <1.2 g/ kg/day (LP group). Patients kept a serial three-day-dietary diary and assessed serum albumin, phosphate, cholesterol and CO2CP every 3 months. Part 1: 126 patients' diaries, which DPI from the three-day-dietary diary was similar to the nPCR, are analyzed. 99 patients' DPI was less than 1.2 g/kg/day with an average calorie intake of 26.93±4.17 KCal/ kg/day. 27 patients' DPI was more than 1.2 g/kg/day with an average calorie intake of 29.46±2.73 KCal/ kg/day. There was no difference on serum albumin. However, the patients in high DPI group have higher serum phosphate and lower CO2CP (TABLE 1). Part 2: The average DPI in LP group was 1.05±0.11 g/kg/day with an average calorie intake of 26.65±3.18 KCal/ kg/day. The average DPI in NP group was 1.34±0.15 g/kg/day with an average calorie intake of 29.1±2.87 KCal/ kg/day. Serum albumin and cholesterol remained stable in both groups. Similarly, the patients in NP group have higher serum phosphate and lower CO2CP compared to LP group (TABLE 2). Conclusion DPI around 1.05 g/kg/day can maintain the nutritional status and ameliorate hyperphosphatemia and acidosis in Chinese MHD patients using low–flux dialyzers

BMI, spKt/V, and SBP but Not DBP Are Related to LVH in Chinese Maintenance Hemodialysis Patients

Objective: Left ventricular hypertrophy (LVH) is the strongest predictor of cardiovascular mortality, the leading cause of death in hemodialysis (HD) patients. This study aims to identify the potential risk factors for LVH in HD patients. Methods: Exactly, 164 patients (84 men and 80 women) who had been on HD treatment for at least 6 months were enrolled. Clinical data were collected. Anthropometric measurements, biochemical analyses, and echocardiography were performed. The risk factors were determined by multivariate linear and logistic regression. Results: In all the patients, the prevalence of LVH was 66.5%. The patients with LVH had higher body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure, and lower single-pool kt/V (spKt/V) compared with those without LVH. Multivariate linear regression showed that BMI (β = 7.608, p = 0.014), SBP (β = 9.462, p = 0.001), and spKt/V (β = –14.226, p = 0.024) were independently correlated with left ventricular mass index (LVMI). Multivariate logistic regression showed the same results that BMI (β = 7.193, p = 0.032), SBP (β = 9.382, p = 0.02), and spKt/V (β = –12.535, p = 0.001) were independently correlated with LVH. Conclusions: In Chinese maintenance hemodialysis patients, BMI, single-pool Kt/V (spKt/V), and SBP were independently correlated with left ventricular mass index and were independent risk factors for LVH.

Application of clinical nursing pathway in health education for hemodialysis patients

Objective To investigate the application of clinical nursing pathway in health education for hemodialysis patients. Methods 84 hemodialysis patients who received holistic nursing practice were divided into test group(n =42) and control group(n =42) according to bed numbers. Test group received health education procedure of clinical nursing pathway, while control group received conventional health education procedure.Compliance rate of health education, compliance rate of dialysis and satisfaction rate of dialysis in the two groups were observed and analyzed. Results Compliance rate of health education, compliance rate of dialysis and satisfaction rate of dialysis were all significantly higher than those of the control group (P < 0. 05). Conclusions Clinical nursing pathway is feasible for Chinese maintenance hemodialysis patients. It contributes to the effect of medical, nursing and health education, thus improves the patients' quality of life. Key words: Clinical nursing pathways; Hemodialysis; Health education