维持性血液透析患者体液状态评估中生物阻抗分析与临床评分的一致性:单中心经验

Kamiti Muchiri, Joshua K Kayima, Elijah N Ogola, Seth McLigeyo, Sally W Ndung'u, Samuel K Kabinga
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引用次数: 0

摘要

背景:慢性肾脏疾病(CKD)的负担在全球范围内迅速上升。液体负荷(FO)是CKD死亡率的独立预测因子,应准确评估,以指导血液透析(HD)期间需要清除的液体量的估计。临床评分(CS)和生物阻抗分析(BIA)已被用于评估FO, BIA在确定HD患者的液体状态方面具有可重复性和准确性。当与BIA进行对比时,需要确定本地开发的CSs在流体状态评估中的性能。目的:评价BIA和CS对维持HD患者水合状态的影响,并评价CS对BIA在体液状态评估中的作用。方法:这是一项以医院为基础的单中心横断面研究,招募了肯雅塔国家医院(Kenyatta National Hospital)接受维持性HD治疗的成年CKD患者。患者年龄在18岁及以上,维持HD至少3个月。排除了使用起搏器、金属植入物或双侧肢体截肢的患者。收集患者的临床病史、体格检查和胸片资料。使用RJL Systems公司生产的Quantum®II生物阻抗分析仪和bc4®软件对每位研究参与者进行BIA。在评价CS的性能时,BIA被认为是金标准试验。构建了一个2 × 2的表格,显示了参与者在每个CS值下的流体状态,与他们配对的BIA结果相比较(分别使用CS和BIA, FO为++、+-、-或-+)。该2 × 2表的结果用于计算CS在各个参考点的敏感性和特异性,随后绘制受试者工作特征(ROC)曲线,用于确定最佳截止点。ROC确定的最佳CS分界点以上和以下的分别为FO阳性和阴性。分别通过CS和BIA诊断为FO的参与者的比例被计算并汇总在一个2 × 2的列联表中进行比较。采用McNemar卡方检验来评估CS和BIA诊断为FO的患者比例是否存在统计学上的显著差异。进行Logistic回归分析以评估透析持续时间、错过的透析次数、卫生保健专业人员对液体或盐摄入量的建议、实际液体摄入量、使用的抗高血压药物数量或体重指数等变量是否与BIA诊断的FO患者的几率相关。结果:从100例符合资格的维持性HD患者中,有80例被招募到本研究中。使用BIA评估时,71例(88.75%)患者液体超载,平均细胞外体积为3.02±1.79 L,而使用CS评估时,47例(58.25%)患者有FO。差异有统计学意义,P值< 0.0001(95%可信区间:0.1758-0.4242)。使用CS,大于4的值表示FO,小于或等于4的值表示没有FO的最佳截止值。CS的敏感性和特异性分别为63%和78%。在多变量logistic回归模型中,评价与FO相关的因素均无统计学意义。结论:FO在肯雅塔国家医院的慢性HD患者中非常普遍。与BIA相比,CS检测FO的频率较低。CS的敏感性和特异性分别为63%和78%。在多变量logistic回归模型中,评价与FO相关的因素均无统计学意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Concordance between bio-impedance analysis and clinical score in fluid-status assessment of maintenance haemodialysis patients: A single centre experience.

Concordance between bio-impedance analysis and clinical score in fluid-status assessment of maintenance haemodialysis patients: A single centre experience.

Concordance between bio-impedance analysis and clinical score in fluid-status assessment of maintenance haemodialysis patients: A single centre experience.

Background: The burden of chronic kidney disease (CKD) is rising rapidly globally. Fluid overload (FO), an independent predictor of mortality in CKD, should be accurately assessed to guide estimation of the volume of fluid to be removed during haemodialysis (HD). Clinical score (CS) and bio-impedance analysis (BIA) have been utilized in assessment of FO and BIA has demonstrated reproducibility and accuracy in determination of fluid status in patients on HD. There is need to determine the performance of locally-developed CSs in fluid status assessment when evaluated against BIA.

Aim: To assess the hydration status of patients on maintenance HD using BIA and a CS, as well as to evaluate the performance of that CS against BIA in fluid status assessment.

Methods: This was a single-centre, hospital-based cross-sectional study which recruited adult patients with CKD who were on maintenance HD at Kenyatta National Hospital. The patients were aged 18 years and above and had been on maintenance HD for at least 3 mo. Those with pacemakers, metallic implants, or bilateral limbs amputations were excluded. Data on the patients' clinical history, physical examination, and chest radiograph findings were collected. BIA was performed on each of the study participants using the Quantum® II bio-impedance analyser manufactured by RJL Systems together with the BC 4® software. In evaluating the performance of the CS, BIA was considered as the gold standard test. A 2-by-2 table of the participants' fluid status at each of the CS values obtained compared to their paired BIA results was constructed (either ++, +-, -- or -+ for FO using the CS and BIA, respectively). The results from this 2-by-2 table were used to compute the sensitivity and specificity of the CS at the various reference points and subsequently plot a receiver operating characteristic (ROC) curve that was used to determine the best cut-off point. Those above and below the best CS cut-off point as determined by the ROC were classified as being positive and negative for FO, respectively. The proportions of participants diagnosed with FO by the CS and BIA, respectively, were computed and summarized in a 2-by-2 contingency table for comparison. McNemar's chi-squared test was used to assess any statistically significant difference in proportions of patients diagnosed as having FO by CS and BIA. Logistic regression analysis was conducted to assess whether the variables for the duration of dialysis, the number of missed dialysis sessions, advisement by health care professional on fluid or salt intake, actual fluid intake, the number of anti-hypertensives used, or body mass index were associated with a patient's odds of having FO as diagnosed by BIA.

Results: From 100 patients on maintenance HD screened for eligibility, 80 were recruited into this study. Seventy-one (88.75%) patients were fluid overloaded when evaluated using BIA with mean extracellular volume of 3.02 ± 1.79 L as opposed to the forty-seven (58.25%) patients who had FO when evaluated using the CS. The difference was significant, with a P value of < 0.0001 (95% confidence interval: 0.1758-0.4242). Using CS, values above 4 were indicative of FO while values less than or equal to 4 denoted the best cut-off for no FO. The sensitivity and specificity for the CS were 63% and 78% respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.

Conclusion: FO is very prevalent in patients on chronic HD at the Kenyatta National Hospital. CS detects FO less frequently when compared with BIA. The sensitivity and specificity for the CS were 63% and 78% respectively. None of the factors evaluated for association with FO showed statistical significance on the multivariable logistic regression model.

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