维持性血液透析患者透析间期体质量增长及其影响因素

lnterdialytic body weight gain and associated factors in maintenance hemodialysis patients

目的厂解维持性血液透析（MHD）患者透析间期的体质量增长情况及影响囚素。方法对复旦大学中山医院肾脏科血液净化中心269例MHD患者作横断面研究。根据患者透析问期体质量增长率（体质量增长量／干体质量×100％）将患者分为≤3．50％（79例）及〉3．50％（190例）两组，分析影响透析间期体质量增长的因素。结果269例MHD患者体质量增长量为（2．42±1．01）kg（0～6．33kg），体质量增长率为（4．25±1．79）％。男性160例，体质量增长量为（2．45±1．09）kg，体质量增长率为（3．99±1．79）％；女性109例，体质量增长量为（2．39±0．85）kg，体质量增长率为（4．64±1．74）％，显著高于男性（P〈0．01）。透析间期体质量增长率〈3．00％的患者占20％，≥3．00％且〈5．00％的占50％，≥5．00％占30％。73．5％的患者体质量增长率超过3．50％。与体质量增长率〉3．50％组比较，≤3．50％组的年龄（岁）（60．50±14．49比54．07±13．78）、男性比例（70．88％比54．74％）、体质量指数（BMI，kg／m2）（22．67±3．36比20．91±3．25）、残余尿量（m1）（自然对数：6．19±0．94比5．48±0．81）、干体质量（kg，62．82±10．97比56．69±10．94）及透析频次明显较高（均P〈0．05）；血液透析龄（月）（41．03±41．92比58．83±43．57），B2微球蛋白（mmol／1．）（31．61±9．82比38．54±10．38）及血磷（mmol／L）（1．92±0．66比2．15±O．58）显著较低（均P〈0．05）：相关分析显示体质量增长率与透析龄、透析前Scr、BUN、磷、B2微球蛋白、透析期间血压下降值和下降率呈正相关，其中透前BUN、Scr、磷及p2微球蛋白经残余尿量校正后，相关性无统计学意义；与年龄、干体质量、BMI、透后收缩压、平均血压及残余尿量呈负相关。结论本组近70％患者体质量增长率控制在5％以内。年龄小、女性、BMI低、残余尿量少、干体质量低、透析龄长、基础病因为慢性‘肾小球肾炎及糖尿病肾病患者在透析阃期体质量增长较多：体质量增长显著影响透析期间的血压变化，应加强MHD患者透析间期的体质量增长的控制：

Objective To study interdialytie body weight gain （IBWG） in maintenance hemodialysis （MHD） patients, and to analyze the associated factors. Methods A total of 269 patients undergoing maintenance hemodialysis were enrolled in this cross-sectlonal study. The patients were divided into two groups according to the percentage of [BWG （P｜BWG： interdialytie body weight gain/dry weight×00%）： PIBWG〉3.50% （190 eases） and PIBWG≤3.50% （79 eases）.Associated factors of IBWG were analyzed. Results The average IBWG of 269 MHD patients was （2..42±1.01） kg （0-6.33 kg）, and PIBWG was （4.25±1.79）%. In male patients, IBWG was （2.45±1.09） kg, and PIBWG was （3.99±1.79）%. In female patients, IBWG was （2.39±0.85） kg, and PIBWG was （4.64±1.74）% which was significantly higher compared to males （P〈0.01）. Patients with PIBWG〈3.00% accounted for 20%, with PIBWG≥3.00% to 〈5.00% accounted for 50%, with PIBWG≥5.00% accounted for 30%. Compared to patients with PIBWG〉3.50%, those with PIBWG ≤ 3.50% were characterized by elder age （year） （60.50±14.49 vs 54.07±13.78）, more males （ 70.88% vs 54.74%）, shorter dialysis duration （month） （41.03±41.92 vs 58.83± 43.57）, larger BMI （kg/m2） （22.67±3.36 vs 20.91±3.25） and less dry weight （kg） （56.69±10.94 vs 62.82±10.97）, more residual urine （ml, In） （6.19±0.94 vs 5.48±0.8）, lower predialysis serum β2- MG （mmol/L） （31.61±9.82 vs 38.54±10.38） and phosphorus（mmol/L） （1.92±0.66 vs 2.15±0.58）. Correlation analysis revealed that PIBWG was positively correlated with dialysis duration, Scr, BUN, β2-MG, phosphorus, decrease and decrease percentage of BP during hemodialysis, and negatively correlated with age, dry weight, BMI, residual urine, and pre-dialysis SBP, MAP. Conclusions PIBWG of about 70% of our patients was below 5%. Young, female, low BMI and dry body weight, long dialysis duration, low residual urine, chronic glomerulonephritis and diabetic nephropathy are associated with more IBWG, which may lead to greater intradialytic BP fluctuation.