Obesity paradox in patients on maintenance dialysis
Obesity paradox in patients on maintenance dialysis
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DOI：
10.1159/000095319
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发表时间：
2006-01-01
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影响因子：
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通讯作者：
Kopple, Joel D.
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作者：
Kalantar-Zadeh, Kamyar;Kopple, Joel D.
超重（体重指数[BMI] = 25-30 kg/m2）和肥胖（BMI > 30 kg/m2）已成为普遍现象，在全世界大多数国家的流行率呈明显上升趋势，并与心血管风险增加和生存率低有关。在接受维持性血液透析的慢性肾病（CKD）患者中，一直报告“肥胖悖论”，即，高BMI与更好的存活率递增相关。虽然维持性血液透析患者中肥胖的“反向流行病学”相对一致，但腹膜透析患者的研究得出了不同的结果。类似的肥胖悖论在慢性心力衰竭患者以及美国2000万其他不同医学“风险”人群中也有描述。肥胖的反向流行病学的可能原因包括：（1）与营养过剩和营养不足相关的不良事件的竞争风险之间的时间差异;（2）尿毒症毒素在脂肪组织中的隔离;（3）在CKD进展过程中选择有利于透析患者更长生存期的基因库，在开始维持透析治疗之前消除了超过95%的慢性肾病人群;（4）更稳定的血流动力学状态;（5）循环细胞因子的改变;（6）独特的神经激素星座;（7）内毒素-脂蛋白相互作用;和（8）反向因果关系。检查透析患者肥胖悖论的原因和后果可以提高我们对慢性透析患者中其他常规风险因素（如血压和血清胆固醇）和其他人群（如心力衰竭、癌症或艾滋病患者或老年人群）中观察到的类似悖论的理解。版权所有（c）2006 S. Karger AG，巴塞尔。
Overweight (body mass index [BMI] = 25-30 kg/m(2)) and obesity (BMI > 30 kg/m(2)) have become mass phenomena with a pronounced upward trend in prevalence in most countries throughout the world and are associated with increased cardiovascular risk and poor survival. In patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis an 'obesity paradox' has been consistently reported, i.e., a high BMI is incrementally associated with better survival. While this 'reverse epidemiology' of obesity is relatively consistent in maintenance hemodialysis patients, studies in peritoneal dialysis patients have yielded mixed results. A similar obesity paradox has been described in patients with chronic heart failure as well as in 20 million members of other distinct medically 'at risk' populations in the USA. Possible causes of the reverse epidemiology of obesity include: (1) time-discrepancies between the competing risks for the adverse events that are associated with overnutrition and undernutrition; (2) sequestration of uremic toxins in adipose tissue; (3) selection of a gene pool favorable to longer survival in dialysis patients during the course of CKD progression, which eliminates over 95% of the CKD population before they commence maintenance dialysis therapy; (4) a more stable hemodynamic status; (5) alterations in circulating cytokines; (6) unique neurohormonal constellations; (7) endotoxin-lipoprotein interactions; and (8) reverse causation. Examining the causes and consequences of the obesity paradox in dialysis patients can improve our understanding of similar paradoxes observed both for other conventional risk factors in chronic dialysis patients, such as blood pressure and serum cholesterol, and in other populations, such as patients with heart failure, cancer or AIDS or geriatric populations. Copyright (c) 2006 S. Karger AG, Basel.