多次人体成分分析的液体参数与血液透析患者心血管事件的相关性

Correlation between fluid parameter and cardiovascular events in hemodialysis patients based on repeated body composition analyses

目的探讨多次人体成分分析的液体负荷指标与血液透析患者心血管事件的相关性。方法前瞻性队列研究,收集2020年7至9月杭州市中医院肾内科维持性血液透析(MHD)患者的临床资料。应用生物电阻抗法测定患者透析前容量超负荷(FO)指标水负荷(OH),每6个月随访监测1次。根据基线OH值分为无FO组(OH≤2.5 L)和FO组(OH>2.5 L),并根据重复测量结果将患者分为持续无FO组、持续FO组及间歇FO组。随访截至2022年10月1日,统计其转归情况,随访终点为心血管事件。采用Kaplan-Meier法计算累积心血管事件发生率,采用Cox比例风险回归模型分析患者心血管事件的危险因素。结果共纳入患者289例,男168例(58.1%),女121例(41.9%),年龄(58±13)岁;FO组88例(30.4%),无FO组201例(69.6%),随访时间(22.0±6.5)个月。Kaplan-Meier曲线分析结果显示,基线FO组心血管事件发生率高于无FO组(log-rank χ^(2)=14.44,P<0.001)。持续FO组和间歇FO组心血管事件发生率均高于持续无FO组(log-rank χ^(2)=41.47,P<0.001;log-rank χ^(2)=18.36,P<0.001)。多因素Cox回归分析结果显示,经性别、年龄、合并症及生化指标校正后,基线FO组患者发生心血管事件的风险是无FO组的1.850倍(95%CI:1.046~3.271,P=0.034);持续FO组患者发生心血管事件的风险是持续无FO组的4.679倍(95%CI:2.189~10.002,P<0.001),间歇FO组患者发生心血管事件的风险是持续无FO组的3.410倍(95%CI:1.696~6.857,P=0.001)。结论生物电阻抗测得的OH值可作为临床上监测MHD患者发生心血管事件的重要参考指标,持续慢性及间歇性暴露于FO均为血液透析患者心血管事件的危险因素。

Objective To explore the correlation between fluid load index and cardiovascular events in hemodialysis patients based on repeated body composition analyses.Methods A prospective cohort study was conducted to collect the clinical data of patients undergoing maintenance hemodialysis(MHD)in the Department of Nephrology,Hangzhou Hospital of Traditional Chinese Medicine from July to September 2020.The pre-dialysis fluid overload(FO)index-overhydration(OH)was measured by bioelectrical impedance method,and the follow-up monitoring was conducted every 6 months.According to the baseline OH value,patients were divided into non-FO group(OH≤2.5 L)and FO group(OH>2.5 L).Moreover,according to the repeated measurements,the patients were divided into continuous non-FO group,continuous FO group and intermittent FO group.All patients were followed up until October 1,2022,and the outcomes were recorded.The end point of follow-up was cardiovascular events.The cumulative incidence of cardiovascular events was calculated by the Kaplan-Meier method,and the risk factors of cardiovascular events were analyzed by Cox proportional hazards regression model.Results A total of 289 patients were included,including 88 patients(30.4%)with FO and 201 patients(69.6%)with non-FO.There were 168 males(58.1%)and 121(41.9%)females,with an average age of(58±13)years and an average follow-up time of(22.0±6.5)months.Kaplan-Meier analysis showed that the incidence of cardiovascular events in the baseline FO group was higher than that in the non-FO group(log-rank χ^(2)=14.44,P<0.001).The incidence of cardiovascular events in both the continuous FO group and the intermittent FO group was higher than that in the continuous non-FO group(log-rank χ^(2)=41.47,P<0.001;log-rank χ^(2)=18.36,P<0.001).After adjustment for gender,age,comorbidities,and biochemical indicators,the incidence of cardiovascular events in the baseline FO group was 1.850 times of the non-FO group(95%CI:1.046-3.271,P=0.034).The incidence of cardiovascular events in the continuous FO group was 4.679 times of the continuous non-FO group(95%CI:2.189-10.002,P<0.001).The incidence of cardiovascular events in the intermittent FO group was 3.410 times of the continuous non-FO group(95%CI:1.696-6.857,P=0.001).Conclusions OH value measured by bioelectrical impedance can be used as an important reference index for clinical monitoring of cardiovascular events in MHD patients.Continuous chronic and intermittent exposures to FO are risk factors for cardiovascular events in hemodialysis patients.