Background
Methods
Patients
Measurement of serum chromium levels and biochemical parameters
Definition of malnutrition and inflammation
Statistical analysis
Results
Study population characteristics
Characteristics | Total patients (n = 647) | 1st quartile (< 0.29 μg/L) (n = 164) | 2nd quartile (0.29–0.56 μg/L) (n = 159) | 3rd quartile (0.57–1.06 μg/L) (n = 163) | 4th quartile (> 1.06 μg/L) (n = 161) |
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Demographics
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Age (years) | 57.9 ± 12.2 | 59.9 ± 12.1 | 58.5 ± 11.7 | 57.3 ± 11.2 | 55.9 ± 12.7 | 0.002 |
Female sex | 316 (48.8) | 81 (49.3) | 88 (55.3) | 78 (47.9) | 69 (42.9) | 0.125 |
Body mass index (kg/m2) | 22.1 ± 3.4 | 22.4 ± 3.7 | 22.4 ± 3.2 | 22.2 ± 3.7 | 21.7 ± 3.2 | 0.062 |
Smoking (Yes) | 76 (11.7) | 10 (6.1) | 4 (2.5) | 9 (5.5) | 13 (8.1) | 0.320 |
Co-Morbidity
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Diabetes mellitus (Yes) | 195 (30.1) | 58 (35.4) | 51 (32.1) | 45 (27.6) | 41 (25.5) | 0.036 |
Hypertension (Yes) | 62 (9.6) | 16 (9.8) | 18 (11.3) | 13 (8.0) | 15 (9.3) | 0.654 |
Previous CVD (Yes) | 50 (7.7) | 16 (9.8) | 8 (5.0) | 10 (6.1) | 16 (9.9) | 0.780 |
Dialysis Related Data
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Hemodialysis vintage (years) | 9.5 ± 6.1 | 9.2 ± 5.8 | 9.2 ± 5.8 | 9.4 ± 6.3 | 10.3 ± 6.5 | 0.119 |
Erythropoietin (U/kg/week) | 61.14 ± 47.1 | 65.5 ± 50.8 | 60.12 ± 45.9 | 60.9 ± 46.1 | 58.0 ± 45.4 | 0.531 |
Fistula as blood access (Yes) | 496 (76) | 120 (73.2) | 122 (76.7) | 122 (74.8) | 132 (82.0) | 0.093 |
Biocompatible membrane dialyzers (Yes) | 556 (85.9) | 145 (88.4) | 141 (88.1) | 122 (74.8) | 148 (91.9) | 0.398 |
Kt/V (Daugirdes) | 1.7 ± 0.3 | 1.74 ± 0.30 | 1.81 ± 0.32 | 1.78 ± 0.31 | 1.78 ± 0.33 | 0.510 |
nPCR (g/kg/day) | 1.21 ± 0.37 | 1.21 ± 0.37 | 1.21 ± 0.37 | 1.23 ± 0.37 | 1.20 ± 0.41 | 0.838 |
Residual daily urine of > 100 mL | 202 (31.2) | 52 (32.5) | 50 (31.4) | 56 (36.6) | 44 (27.3) | 0.538 |
Biochemical Data
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Hemoglobin (g/dL) | 10.32 ± 1.22 | 10.14 ± 1.27 | 10.24 ± 1.21 | 10.38 ± 1.19 | 10.53 ± 1.20 | 0.003 |
Albumin (g/dL) | 3.98 ± 0.33 | 3.94 ± 0.32 | 3.98 ± 0.34 | 4.01 ± 0.34 | 3.99 ± 0.32 | 0.087 |
Albumin of < 3.6 g/dL | 75 (11.5) | 26 (20.6) | 19 (11.9) | 17 (10.4) | 13 (8.1) | 0.019 |
Creatinine (mg/dL) | 10.99 ± 2.38 | 10.8 ± 2.6 | 10.8 ± 2.2 | 11.1 ± 2.4 | 11.3 ± 2.4 | 0.020 |
Transferrin saturation (%) | 26.3 ± 11.4 | 28.0 ± 12.6 | 26.8 ± 10.9 | 26.9 ± 12.0 | 23.8 ± 10.0 | 0.003 |
Ferritin (μg/L) | 260.7 (79.8, 467.3) | 321.7 (110.8, 504.6) | 336.6 (99.2, 480.5) | 257.0 (71.2, 487.1) | 144.4 (53.6, 383.5) | 0.001 |
Corrected-calcium (mg/dL) | 9.86 ± 0.93 | 9.7 ± 0.9 | 10.0 ± 1.0 | 9.9 ± 0.8 | 9.8 ± 1.0 | 0.236 |
Phosphate (mg/dL) | 4.82 ± 1.31 | 4.6 ± 1.3 | 4.9 ± 1.2 | 4.8 ± 1.2 | 4.9 ± 1.4 | 0.137 |
Intact parathyroid hormone (pg/mL) | 239.1 (88.8, 444.4) | 216.2 (80.4 408.6) | 249.1 (86.9, 423.5) | 230.3 (98.6, 472.7) | 248.1 (103.0, 475.3) | 0.229 |
HsCRP (mg/L) | 2.59 (1.21, 7.04) | 2.88 (1.28, 8.93) | 2.51 (1.07, 6.16) | 2.71 (1.36, 6.34) | 2.40 (1.25, 7.24) | 0.296 |
HsCRP of > 3.0 mg/dL | 296 (45.7) | 78 (47.6) | 69 (43.3) | 78 (47.9) | 71 (44.1) | 0.732 |
Cardiovascular Risks
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Cholesterol (mg/dL) | 171.7 ± 37.3 | 170.3 ± 35.1 | 174.1 ± 39.3 | 172.8 ± 38.2 | 170.0 ± 36.7 | 0.865 |
Triglyceride (mg/dL) | 142.4 ± 97.3 | 141.6 ± 96.8 | 142.0 ± 103.7 | 147.6 ± 105.6 | 138.6 ± 82.1 | 0.924 |
Serum chromium (μg/L) | 0.57 (0.29, 1.06) | 0.20 (0.14, 0.24) | 0.39 (0.34, 0.46) | 0.80 (0.65,0.92) | 1.59 (1.26, 2.26) | < 0.001 |
Water and dialysate chromium levels
Determinants of SCLs in MHD patients
Simple linear regression analysis |
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| Forward stepwise multiple linear regression analysis |
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| |
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Variables | Coefficient ± SE | β coefficient ± SE | ||
Age (years) | −0.004 ± 0.001 | 0.002 | ||
Body mass index (kg/m2) | −0.011 ± 0.005 | 0.024 | − 0.010 ± 0.005 | 0.041 |
Hemodialysis vintage (years) | 0.005 ± 0.003 | 0.050 | ||
Diabetes mellitus (Yes = 1) | −0.096 ± 0.036 | 0.008 | ||
Albumin of < 3.6 g/dL (Yes = 1) | −0.131 ± 0.051 | 0.011 | − 0.129 ± 0.051 | 0.012 |
Hemoglobin (mg/dL) | 0.041 ± 0.013 | 0.002 | ||
Creatinine (mg/dL) | 0.014 ± 0.007 | 0.042 | ||
Transferrin saturation (%) | −0.003 ± 0.001 | 0.020 | ||
Log ferritin (pg/mL) | −0.111 ± 0.033 | 0.001 | − 0.107 ± 0.031 | 0.001 |
Probability of malnutrition in MHD patients
Univariate logistic regression analysis |
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| Forward stepwise multivariate logistic regression analysis |
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| |
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Variables | Odds ratio (95% confidence interval) | Odds ratio (95% confidence interval) | ||
Age > 65 years (Yes vs. No) | 3.40 (2.09–5.55) | < 0.001 | 1.80 (1.02–3.19) | 0.043 |
Diabetes mellitus (Yes vs. No) | 1.71 (1.04–2.79) | 0.033 | ||
Using catheter as blood access (Yes vs. No) | 3.66 (1.35–10.0) | 0.011 | ||
Cholesterol (mg/dL) (each increase, 1 mg/dL) | 0.98 (0.98–0.99) | < 0.001 | 0.99 (0.98–1.00) | 0.005 |
Triglyceride (mg/dL) (each increase, 1 mg/dL) | 1.00 (0.99–1.00) | 0.032 | ||
Hemoglobin (g/dL) | 0.55 (0.45–0.69) | < 0.001 | ||
Creatinine (mg/dL) (each increase, 1 mg/dL) | 0.65 (0.58–0.74) | < 0.001 | 0.73 (0.64–0.84) | < 0.001 |
Phosphate (mg/dL) (each increase, 1 mg/dL) | 0.67 (0.55–0.82) | < 0.001 | ||
nPCR (g/kg/day) | 0.45 (0.22–0.93) | 0.030 | ||
Log SCL (μg/L) (each increase, 10 μg/L) | 0.46 (0.25–0.83) | < 0.001 | 0.49 (0.25–0.96) | 0.039 |
hsCRP of > 3.0 mg/L (Yes vs. No) | 2.90 (1.74–4.84) | < 0.001 | 2.15 (1.22–3.82) | 0.009 |
Probability of inflammation in MHD patients
Univariate logistic regression analysis |
p
| Forward stepwise multivariate logistic regression analysis |
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| |
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Variables | Odds ratio (95% confidence interval) | Odds ratio (95% confidence interval) | ||
Age > 65 years (Yes vs. No) | 1.68 (1.18–2.39) | 0.004 | ||
Body mass index (kg/m2) (each increase, 1 kg/m2) | 1.14 (1.08–1.20) | < 0.001 | 1.15 (1.08–1.22) | < 0.001 |
Diabetes mellitus (Yes vs. No) | 1.96 (1.39–2.75) | < 0.001 | ||
Using catheter as blood access (Yes vs. No) | 2.67 (1.00–7.14) | 0.011 | ||
Kt/V (Daugirdes) (each increase, 1) | 0.35 (0.21–0.59) | < 0.001 | ||
nPCR (each increase, 1 g/kg/day) | 0.57 (0.37–0.87) | 0.010 | ||
Triglyceride (mg/dL) (each increase, 1 mg/dL) | 1.00 (1.00–1.01) | < 0.001 | 1.00 (1.00–1.01) | 0.001 |
Hemoglobin (g/dL) | 0.81 (0.71–0.93) | 0.002 | 0.80 (0.67–0.95) | 0.012 |
Creatinine (mg/dL) (each increase, 1 mg/dL) | 0.93 (0.87–0.99) | 0.022 | ||
Transferrin saturation (%) (each increase, 1%) | 0.97 (0.95–0.98) | < 0.001 | 0.96 (0.94–0.97) | 0.001 |
Log Ferritin (each increase, 10) | 1.62 (1.18–2.22) | 0.003 | 1.95 (1.28–2.99) | 0.002 |
Albumin of < 3.6 g/dL (Yes vs. No) | 2.91 (1.74–4.83) | < 0.001 | 2.96 (1.61–5.43) | < 0.001 |