透析间期体重增长变异度与老年维持性血液透析患者预后的关系研究

Relationship between intradialytic weight gain coefficient of variation and outcomes in elderly patients on maintenance hemodialysis

目的探讨透析间期体重增长(IDWG)变异度与老年维持性血液透析患者预后的关系。方法选取2018年3月至2022年12月行维持性血液透析的152例老年血液透析患者为研究对象。收集患者的临床、实验室检查资料并计算患者的IDWG变异度。对所有纳入的患者进行随访,随访终点为全因死亡或主要心血管事件组成的复合终点。根据IDWG变异度中位数将患者分为低IDWG变异度组(n=76)和高IDWG变异度组(n=76)。使用Kaplan-Meier生存曲线比较不同IDWG变异度组患者终点事件发生率,单因素和多因素Cox回归明确IDWG对复合终点的预测意义。结果同低IDWG变异度组相比,高IDWG变异度组患者合并糖尿病比例和透前收缩压、舒张压和血红蛋白显著升高(均P<0.05)。Kaplan-Meier生存曲线提示低IDWG变异度组中位无随访终点事件率显著高于高IDWG变异度组(50月vs 34月,P=0.04)。单因素和多因素Cox回归均证实,IDWG变异度>0.34是老年维持性血液透析患者终点事件发生的独立危险因素(HR=2.01,95%CI 1.04~3.97,P=0.03)。结论IDWG变异度过大的老年维持性血液透析患者预后不良,保持IDWG恒定可能有助于改善患者预后。

Objective To investigate the relationship between intradialytic weight gain(IDWG)coefficient of variability and outcomes in elderly patients on maintenance hemodialysis.Methods A total of 152 elderly patients on maintenance hemodialysis from March 2018 to December 2022 were included.Patient clinical and laboratory data were collected and the IDWG coefficient of variability were calculated.All patients were followed up with a composite endpoint of all-cause mortality or major cardiovascular events.Patients were divided into the low IDWG variability(n=76)and high IDWG variability group(n=76)based on median IDWG variability.The Kaplan-Meier survival curve was used to compare the event rates in patients with different IDWG variability groups,and univariate and multivariate Cox regression were used to clarify the predictive significance of IDWG on composite endpoints.Results Compared with the low IDWG variability group,the proportion of diabetes mellitus,pre-dialysis diastolic,diastolic blood pressure and hemoglobin concentration in the group with high IDWG variability were significantly increased(all P<0.05).The Kaplan-Meier survival curve showed that the median endpoint event-free rate was significantly higher in the low IDWG variability group than that in the high IDWG variability group(50 months vs 34 months,P=0.04).Both univariate and multivariate Cox regression confirmed that IDWG coefficient of variability>0.34 was an independent risk factor for unfavorable outcomes in elderly maintenance hemodialysis patients(HR=2.01,95%CI 1.04-3.97,P=0.03).Conclusion Elderly patients on maintenance hemodialysis with excessive IDWG variation were associated with a poor prognosis,and keeping IDWG constant may help improve patient outcomes.