Effect of continuous quality improvement on protein energy wasting in maintenance dialysis patients

Objective To explore the effect of continuous quality improvement(CQI) on protein energy wasting(PEW) in maintenance hemodialysis patients. Methods From July 2016 to June 2017, 85 PEW patients undergoing routine hemodialysis at blood purification center were selected. Through the establishment of CQI team and the application of CQI program, the management objects included patients, their families and implementing "PDCA"(plan, do, check & act) during treatment. The observation period lasted 12 months. Serum albumin(Alb), serum prealbumin(PA), transferrin(TF) and serum cholesterol(serum) before and after CQI were compared cholesterol Tch, hemoglobin(Hb), serum creatinine(Scr), urea nitrogen(BUN), serum hypersensitive C-reactive protein(hs CRP), body mass index(BMI), normalized protein catabolic rate(nPCR), mid arm circumference(MAC) and mid arm circumference(MAMC) were measured. Serum calcium, phosphorus, parathyroid hormone(iPTH) and modified quantitative and global assessment(MQSGA) were recorded. And the impact of CQI on these indicators was observed. Results After CQI, the average levels of Alb(g/L), PA(mg/L), TF(mg/L), Tch(mmol/L), Hb(g/L) and BMI(kg/m²) were markedly higher than before(34.34±3.97 vs 37.26±3.33, 252.9±41.7 vs 295.1±39.0, 1.52±0.24 vs 1.99±0.25, 2.93±0.84 vs 4.23±0.97, 83.88±16.75 vs 94.12±13.46, 27.58±6.84 vs 28.16±5.78, P<0.05). The average level of hs CRP decreased from(20.85±2.09) to(13.15±1.74) mg/L(t=5.02, P<0.01), MAC increased from(22.02±1.63) to(24.81±1.26) mm(t=5.02, P<0.01) and MAMC rose from(20.68±1.47) to(22.74±1.40) mm(t=2.603, P=0.017), nPCR increased from(0.85±0.92) g·kg^-1·d^-1 to(1.21±0.21) g·kg^-1·d^-1(t=1.154, P=0.022), mild proportion increased from 77.65% to 88.23%(χ²=4.61, P=0.002), moderate proportion declined from 18.82% to 10.59%(χ²=3.69, P=0.017) and severe proportion dropped from 3.5% to 1.33%(χ²=5.05, P<0.001). The average level of serum calcium showed little change(t=0.629, P=0.537), proportion of attaining the standard spiked from 52% to 66.7%(χ²=2.36, P<0.05);average level of blood phosphorus decreased from(2.11±0.24) to(1.80±0.23) mmol/L(t=-0.459, P<0.05), average level of iPTH declined from(40.79±18.67) to(24.41±9.82) pmol/L(t=-5.566, P<0.001) and proportion of reaching the standard jumped from 47.62% to 71.43%(χ²=4.69, P<0.001). Conclusion CQI can significantly improve the comprehensive nutritional status of patients and the proportion of patients with blood calcium, blood phosphorus and iPTH compliance has significantly improved. There is no occurrence of calcium and phosphorus metabolism disorder or secondary parathyroid dysfunction.