中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (03): 162-166.doi: 10.3969/j.issn.1671-4091.2022.03.005

• 临床研究 • 上一篇    下一篇

维持性血液透析患者透析后容量负荷过重与长期预后的关系

朱丽1,杨冰1,蔡美顺1,赵新菊1,王琰1,倪梦凡1,赵玉超1,甘良英1,左力1   

  1. 1. 北京大学人民医院肾脏内科
  • 收稿日期:2021-12-27 修回日期:2021-12-29 出版日期:2022-03-12 发布日期:2022-03-16
  • 通讯作者: 甘良英 ganliangying@yahoo.com E-mail:ganliangying@medmail.com.cn
  • 基金资助:
    北京市科学技术委员会首都临床特色应用研究支持项目(Z131107002213122)

Relationship between post-dialytic overhydration and long-term prognosis in maintenance hemodialysis patients

  1. 1Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
  • Received:2021-12-27 Revised:2021-12-29 Online:2022-03-12 Published:2022-03-16

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摘要： 【摘要】目的探讨应用生物电阻抗技术测定透析后容量负荷过重(细胞外液与总体液比值升高)对维持性血液透析(maintenance hemodialysis，MHD)患者全因死亡的预测作用。方法入选北京大学人民医院肾内科临床无显性水肿的MHD 患者，应用赛康mBCA515 生物电阻抗分析仪测量患者透析后总体液(total body water,TBW)、细胞外液(extracellular water,ECW)和细胞内液(intracellular water, ICW)、肌肉及脂肪质量等，记录患者一般资料、血压、化验、超声心动等数据，定义ECW/TBW%＞正常上限为透析后容量负荷过重(over hydration,OH)，进行随访，观察终点为全因死亡。以全因死亡为因变量，透析后OH 为研究自变量，单因素分析有统计学差异和既往研究中存在临床意义的变量作为校正变量，共同纳入多因素COX 回归分析，探讨MHD 透析后OH 对全因死亡的预测作用。结果①入选119 例MHD 患者，随访4年，随访期间肾移植2 例，最终入组117 例(男/女：73/44)，年龄(58±15)岁，透析龄中位数67(39，120)月。随访结束时死亡21 例(17.9%)。②多因素COX 回归分析提示：经年龄、透析龄等多因素校正后，透析后OH (HR= 17.459, 95% CI：2.801～108.832,P=0.002)是MHD 患者全因死亡的独立危险因素。结论透析后细胞外液与总体液比值可敏感识别无显性水肿的MHD 患者容量状态，透析后容量负荷较重是维持性血液透析患者全因死亡的独立危险因素，需给予患者容量管理更多关注。

关键词: 血液透析, 细胞外液与总体液比值, 容量负荷过重, 死亡, 内脏脂肪

Abstract: 【Abstract】Objective To explore the role of post-dialytic overhydration (OH) determined by bioelectrical impedance technique in the prediction of all- cause death in maintenance hemodialysis (MHD) patients. Methods A total of 117 MHD patients without edema from Peking University People's Hospital were recruited for the observation. Their total body water (TBW), extracellular water (ECW), intracellular water (ICW), fat mass and muscle mass after dialysis were measured by bioelectrical impedance analyzer. The ECW/TBW ratio higher than that of normal upper limit after hemodialysis was defined as post-dialytic OH. Blood pressure, laboratory tests and echocardiography were recorded. The primary endpoint was all-cause death in the follow-up period of 4 years. Multivariate COX regression analysis was conducted to explore the predictive effect of post-dialytic OH on all-cause death in MHD patients using all-cause death as the dependent variable, post-dialytic OH as the independent variable, and statistically significant variables in univariate analysis and clinically significant variables in previous studies as the correction variables. Results ①A total of 117 patients (73 males and 44 females, average age 58±15 years old) on MHD for 67 (39, 120) months were included in this study. They were followed up for 4 years, and 21 cases died (17.9%) and 96 cases survived in the
follow-up period. ②Multivariate COX regression analysis showed that post-dialytic OH was an independent risk factor for all-cause death (HR=17.459, 95% CI 2.801～108.832, P=0.002) in MHD patients after adjusting for a variety of factors. Conclusions Post-dialytic ECW/TBW ratio was a sensitive biomarker of volume status in MHD patients without evident edema. Post-dialytic OH was an independent risk factors for all-cause death in MHD patients. Therefore, volume management should be carefully conducted in MHD patients.

Key words: Hemodialysis, Ratio of extracellular water to total body water, Overhydration, Death, Visceral fat

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