Body mass index, dialysis modality, and survival: Analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study
Body mass index, dialysis modality, and survival: Analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study
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DOI：
10.1111/j.1523-1755.2004.00385.x
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发表时间：
2004-02-01
影响因子：
19.6
通讯作者：
Kimmel, PL
中科院分区：
文献类型：
--
作者：
Abbott, KC;Glanton, CW;Kimmel, PL
背景。尚未评估肥胖对终末期肾病 (ESRD) 患者生存与透析方式（即血液透析与腹膜透析的直接比较）的影响，调整药物使用、随访 2 年的差异或考虑透析方式的变化。方法。我们对 1996 年开始透析的美国肾脏数据系统 (USRDS) 透析发病率和死亡率第二波研究 (DMMS) 患者进行了一项回顾性队列研究，并随访至 2001 年 10 月 31 日。Cox 回归分析用于建立体重指数 (BMI) 类别死亡率的调整风险比 (AHR) 模型，均以四分位数表示，并且大于或等于 30 kg/m(2) 对比更低。由于在研究期间腹膜透析患者转为血液透析的比例如此之大（45.5%），因此进行了敏感性分析，计算从腹膜透析转为血液透析之日审查和不审查的生存时间。结果。血液透析患者1675例，腹膜透析患者1662例。在血液透析患者中，BMI大于或等于30 kg/m(2)的患者5年生存率为39.8%，而BMI较低的患者为32.3%（对数秩检验P < 0.01）。在腹膜透析患者中，BMI 30 kg/m(2) 患者的 5 年生存率为 38.7%，BMI 较低的患者为 40.4%（对数秩检验 P > 0.05）。在调整分析中，BMI大于或等于30 kg/m(2)与血液透析患者的生存率改善相关（AHR 0.89；95% CI 0.81, 0.99；P = 0.042），但与腹膜透析患者无关（AHR = 0.99；95% CI，0.86, 1.15；P = 0.89）。从腹膜透析改为血液透析的审查结果没有差异。结论。我们的结论是，与血液透析患者相比，腹膜透析患者在慢性透析患者中与肥胖相关的任何生存优势的可能性明显较小。
Background. The impact of obesity on survival in end-stage renal disease (ESRD) patients as related to dialysis modality (i.e., a direct comparison of hemodialysis with peritoneal dialysis) has not been assessed adjusting for differences in medication use, follow-up 2 years, or accounting for changes in dialysis modality.Methods. We performed a retrospective cohort study of the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Wave II Study (DMMS) patients who started dialysis in 1996, and were followed until October 31 2001. Cox regression analysis was used to model adjusted hazard ratios (AHR) for mortality for categories of body mass index (BMI), both as quartiles and as greater than or equal to30 kg/m(2) vs. lower. Because such a large proportion of peritoneal dialysis patients changed to hemodialysis during the study period (45.5%), a sensitivity analysis was performed calculating survival time both censoring and not censoring on the date of change from peritoneal dialysis to hemodialysis.Results. There were 1675 hemodialysis and 1662 peritoneal dialysis patients. Among hemodialysis patients, 5-year survival for patients with BMI greater than or equal to30 kg/m(2) was 39.8% vs. 32.3% for lower BMI (P < 0.01 by log-rank test). Among peritoneal dialysis patients, 5-year survival for patients with BMI 30 kg/m(2) was 38.7% vs. 40.4% for lower BMI (P > 0.05 by log-rank test). In adjusted analysis, BMI greater than or equal to30 kg/m(2) was associated with improved survival in hemodialysis patients (AHR 0.89; 95% CI 0.81, 0.99; P = 0.042) but not peritoneal dialysis patients (AHR = 0.99; 95% CI, 0.86, 1.15; P = 0.89). Results were not different on censoring of change from peritoneal dialysis to hemodialysis.Conclusion. We conclude that any survival advantage associated with obesity among chronic dialysis patients is significantly less likely for peritoneal dialysis patients, compared to hemodialysis patients.