Effect of individualized hemodialysis on dialysis complications in elderly patients with diabetic nephropathy

doi:10.3969/j.issn.1004-583X.2024.04.006

Abstract

Abstract:

Objective To explore the effect of individualized hemodialysis on dialysis complications in elderly patients with diabetic nephropathy (DN). Methods A total of 80 elderly hemodialysis patients with end-stage renal disease (ESRD) admitted in our hospital were selected, including 40 DN patients (DN group) and 40 non-DN (NDN group). They were further divided into DN1 subgroup and DN2 subgroup, as well as NDN1 subgroup and NDN2 subgroup, with 20 cases per group. Patients in DN1 and NDN1 group were given an individualized hemodialysis, and those in DN2 and NDN2 group were given a routine hemodialysis. After the observation for 1 year, the incidence of complications like hypotension, hypoglycemia, limb spasm and hypertension was compared. The decline rate of serum albumin (ALB), hemoglobin (Hg) and blood urea nitrogen (BUN) were recorded. Results After an individualized or routine dialysis, the frequency (number of times) of hypotension (11.0 vs 3.5, 19.5 vs 9.5), hypoglycemia (5.0 vs 0.0, 11.5 vs 3.5) and limb spasms (3.0 vs 0.0, 9.5 vs 1.0) was significantly higher in DN group than those of NDN group (P<0.01). Hypertension during dialysis was only found significantly more frequent in DN2 subgroup than that of NDN2 subgroup (18.0 vs 5.5, P<0.01). Compared with those of routine dialysis in DN group and NDN group, an individualized dialysis in both groups significantly reduced the frequency (number of times) of hypotension (11.0 vs 19.5, 3.5 vs 9.5), hypoglycemia (5.0 vs 11.5, 0.0 vs 3.5) and limb spasms (3.0 vs 9.5, 0.0 vs 1.0) (P<0.05). Hypertension during dialysis was only found significantly less frequent in DN1 subgroup than that of DN2 subgroup (10.0 vs 18.0, P<0.05). After an individualized or routine dialysis, there were no significant differences in ALB (40.80±2.84 g/L vs 42.75±4.56 g/L, 42.40±4.17 g/L vs 42.65±2.92 g/L), Hg (103.50±15.37 g/L vs 109.90±9.71 g/L, 108.60±13.80 g/L vs 112.90±7.81 g/L) and urea nitrogen reduction rate (URR%) (56.10%±8.01% vs 63.95%±6.05%, 59.70%±5.28% vs 63.15%±5.86%) between DN group and NDN group (P>0.05). Compared with those of routine dialysis in DN group and NDN group, there were no significant differences in ALB (40.80±2.84 g/L vs 43.40±4.17 g/L, 42.55±4.56 g/L vs 42.65±2.92 g/L), Hg (103.50±15.37 g/L vs 108.60±13.80 g/L, 109.90±9.71 g/L vs 112.90±7.81 g/L) and URR% (56.10%±8.01% vs 59.70%±5.28%, 63.95%±6.05% vs 63.15%±5.86%)(P>0.05). Conclusion The incidence of complications during dialysis is high in elderly patients with DN. An individualized dialysis is effective in reducing the above complications without affecting the dialysis effect.

Key words: diabetic nephropathies, aged, renal dialysis, complications, individualized hemodialysis

CLC Number:

R587.24

Wang Chunjie, Xie Jing, Han Xue, Wu Dan, Chen Jianhua. Effect of individualized hemodialysis on dialysis complications in elderly patients with diabetic nephropathy[J]. Clinical Focus, 2024, 39(4): 332-336.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.04.006

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I4/332

Figures/Tables 9

Tab.1 Comparison of general data between groups

组别	例数	性别[例(%)]		年龄 (岁)	透析时间 (月)
组别	例数	男性	女性	年龄 (岁)	透析时间 (月)
DN1组	20	9(45.0)	11(55.0)	64.20±5.81	7.30±2.30
DN2组	20	9(45.0)	11(55.0)	64.55±3.85	7.03±2.28
NDN1组	20	12(60.0)	8(40.0)	68.90±5.55	7.27±2.52
NDN2组	20	11(55.0)	9(45.0)	65.60±3.70	7.48±2.40
统计值		χ²=1.114		$t$ =2.101	$t$ =1.215
$P$ 值		0.142		0.071	0.162

Tab.1 Comparison of general data between groups

组别	例数	性别[例(%)]		年龄 (岁)	透析时间 (月)
组别	例数	男性	女性	年龄 (岁)	透析时间 (月)
DN1组	20	9(45.0)	11(55.0)	64.20±5.81	7.30±2.30
DN2组	20	9(45.0)	11(55.0)	64.55±3.85	7.03±2.28
NDN1组	20	12(60.0)	8(40.0)	68.90±5.55	7.27±2.52
NDN2组	20	11(55.0)	9(45.0)	65.60±3.70	7.48±2.40
统计值		χ²=1.114		$t$ =2.101	$t$ =1.215
$P$ 值		0.142		0.071	0.162

Tab.2 Frequency of complications in elderly dialysis patients with individualized hemodialysis regimens ( M [P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
DN1组	20	11.0(10.0, 15.8)	5.0(4.0, 6.8)	3.0(2.0, 5.8)	10.0(2.0, 22.8)
NDN1组	20	3.5(2.3, 6.8)	0.0(0.0, 0.8)	0.0(0.0, 1.0)	5.5(4.0, 16.0)
$Z$ 值		-4.531	-4.984	-4.446	-0.761
$P$ 值		<0.01	<0.01	<0.01	0.447

Tab.2 Frequency of complications in elderly dialysis patients with individualized hemodialysis regimens ( M [P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
DN1组	20	11.0(10.0, 15.8)	5.0(4.0, 6.8)	3.0(2.0, 5.8)	10.0(2.0, 22.8)
NDN1组	20	3.5(2.3, 6.8)	0.0(0.0, 0.8)	0.0(0.0, 1.0)	5.5(4.0, 16.0)
$Z$ 值		-4.531	-4.984	-4.446	-0.761
$P$ 值		<0.01	<0.01	<0.01	0.447

Tab.3 Frequency of complications in elderly dialysis patients with conventional hemodialysis protocol ( M[P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
DN2组	20	19.5(16.5, 26.8)	11.5(8.3, 13.0)	9.5(8.0, 11.0)	18.0(8.0, 35.5)
NDN2组	20	9.5(6.0, 12.3)	3.5(2.0, 4.8)	1.0(1.0, 2.0)	5.5(2.0, 9.8)
$Z$ 值		-4.963	-5.077	-5.218	-3.645
$P$ 值		<0.01	<0.01	<0.01	<0.01

Tab.3 Frequency of complications in elderly dialysis patients with conventional hemodialysis protocol ( M[P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
DN2组	20	19.5(16.5, 26.8)	11.5(8.3, 13.0)	9.5(8.0, 11.0)	18.0(8.0, 35.5)
NDN2组	20	9.5(6.0, 12.3)	3.5(2.0, 4.8)	1.0(1.0, 2.0)	5.5(2.0, 9.8)
$Z$ 值		-4.963	-5.077	-5.218	-3.645
$P$ 值		<0.01	<0.01	<0.01	<0.01

Tab.4 Frequency of complications at different dialysis regimens in NDN group ( M [P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
NDN1组	20	3.5(2.3, 6.8)	0.0(0.0, 0.8)	0.0(0.0, 1.0)	5.5(4.0, 16.0)
NDN2组	20	9.5(6.0, 12.3)	3.5(2.0, 4.8)	1.0(1.0, 2.0)	5.5(2.0, 9.8)
$Z$ 值		-3.531	-4.534	-2.569	-1.115
$P$ 值		<0.01	<0.01	0.010	0.265

Tab.4 Frequency of complications at different dialysis regimens in NDN group ( M [P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
NDN1组	20	3.5(2.3, 6.8)	0.0(0.0, 0.8)	0.0(0.0, 1.0)	5.5(4.0, 16.0)
NDN2组	20	9.5(6.0, 12.3)	3.5(2.0, 4.8)	1.0(1.0, 2.0)	5.5(2.0, 9.8)
$Z$ 值		-3.531	-4.534	-2.569	-1.115
$P$ 值		<0.01	<0.01	0.010	0.265

Tab.5 Frequency of complications at different dialysis regimens in DN group ( M [P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
DN1组	20	11.0(10.0, 15.8)	5.0(4.0, 6.8)	3.0(2.0, 5.8)	10.0(2.0, 22.8)
DN2组	20	19.5(16.5, 26.8)	11.5(8.3, 13.0)	9.5(8.0, 11.0)	18.0(8.0, 35.5)
$Z$ 值		-4.329	-4.127	-4.374	-1.815
$P$ 值		<0.01	<0.01	<0.01	0.047

Tab.5 Frequency of complications at different dialysis regimens in DN group ( M [P25, P75])

组别	例数	低血压	低血糖	肢体痉挛	高血压
DN1组	20	11.0(10.0, 15.8)	5.0(4.0, 6.8)	3.0(2.0, 5.8)	10.0(2.0, 22.8)
DN2组	20	19.5(16.5, 26.8)	11.5(8.3, 13.0)	9.5(8.0, 11.0)	18.0(8.0, 35.5)
$Z$ 值		-4.329	-4.127	-4.374	-1.815
$P$ 值		<0.01	<0.01	<0.01	0.047

Tab.6 Comparison of nutritional indicators and dialysis effects using individualized dialysis regimens in elderly ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
DN1组	20	40.80±2.84	103.50±15.37	56.10±8.01
NDN1组	20	42.75±4.56	109.90±9.71	63.95±6.05
$t$ 值		-1.622	-1.574	-3.499
$P$ 值		0.113	0.125	0.051

Tab.6 Comparison of nutritional indicators and dialysis effects using individualized dialysis regimens in elderly ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
DN1组	20	40.80±2.84	103.50±15.37	56.10±8.01
NDN1组	20	42.75±4.56	109.90±9.71	63.95±6.05
$t$ 值		-1.622	-1.574	-3.499
$P$ 值		0.113	0.125	0.051

Tab.7 Comparison of nutritional indicators and dialysis effect in elderly patients undergoing dialysis under conventional dialysis scheme ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
DN2组	20	42.40±4.17	108.60±13.80	59.70±5.28
NDN2组	20	42.65±2.92	112.90±7.81	63.15±5.86
$t$ 值		0.658	-1.213	-1.956
$P$ 值		0.514	0.235	0.058

Tab.7 Comparison of nutritional indicators and dialysis effect in elderly patients undergoing dialysis under conventional dialysis scheme ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
DN2组	20	42.40±4.17	108.60±13.80	59.70±5.28
NDN2组	20	42.65±2.92	112.90±7.81	63.15±5.86
$t$ 值		0.658	-1.213	-1.956
$P$ 值		0.514	0.235	0.058

Tab.8 Comparison of nutritional indicators and dialysis effect in DN group under different dialysis schemes ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
DN1组	20	40.80±2.84	103.50±15.37	56.10±8.01
DN2组	20	43.40±4.17	108.60±13.80	59.70±5.28
$t$ 值		-2.304	-1.104	-1.679
$P$ 值		0.057	0.277	0.101

Tab.8 Comparison of nutritional indicators and dialysis effect in DN group under different dialysis schemes ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
DN1组	20	40.80±2.84	103.50±15.37	56.10±8.01
DN2组	20	43.40±4.17	108.60±13.80	59.70±5.28
$t$ 值		-2.304	-1.104	-1.679
$P$ 值		0.057	0.277	0.101

Tab.9 Comparison of nutritional indicators and dialysis effects under different dialysis regimens in NDN group ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
NDN1组	20	42.55±4.56	109.90±9.71	63.95±6.05
NDN2组	20	42.65±2.92	112.90±7.81	63.15±5.86
$t$ 值		0.083	-1.077	0.425
$P$ 值		0.935	0.288	0.673

Tab.9 Comparison of nutritional indicators and dialysis effects under different dialysis regimens in NDN group ($\bar{x}±s$)

组别	例数	血白蛋白(g/L)	血红蛋白(g/L)	URR(%)
NDN1组	20	42.55±4.56	109.90±9.71	63.95±6.05
NDN2组	20	42.65±2.92	112.90±7.81	63.15±5.86
$t$ 值		0.083	-1.077	0.425
$P$ 值		0.935	0.288	0.673

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