Underweight Is an Independent Risk Factor for Renal Function Deterioration in Patients with IgA Nephropathy.
Underweight Is an Independent Risk Factor for Renal Function Deterioration in Patients with IgA Nephropathy.
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体重不足是 IgA 肾病患者肾功能恶化的独立危险因素
DOI：
10.1371/journal.pone.0162044
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Chen N
中科院分区：
文献类型：
--
作者：
Ouyang Y;Xie J;Yang M;Zhang X;Ren H;Wang W;Chen N
关于体重指数(BMI)与IgA肾病(IgAN)肾脏进展关系的研究较少，尤其是对体重偏低的IgA肾病患者。为了阐明低体重对本病肾功能恶化的影响及其临床特征，我们在1985年至2014年间从本中心招募了诊断年龄≥为18岁、基线估计肾小球滤过率(≥)为15ml/min/1.73m2的IgA肾病患者。排除继发于全身性疾病或随访<6个月的患者。记录所有患者在肾活检时和随访期的临床资料。肾脏结局定义为终末期肾病(ESRD)。基线体重指数(BMI)由体重(Kg)除以身高平方(M2)计算。根据世界卫生组织亚洲指南，体重指数分为：体重不足18.5 kg/m2、正常体重18.5~22.99 kg/m2、超重23~27.49 kg/m2、肥胖(≥27.5 kg/m2)。在这项研究中登记的930名原发性IgA肾病患者中，肾活检的平均年龄为37.6岁，其中49.2%是男性。平均随访47.1个月，114例(12.3%)发生终末期视网膜病变。体重不足患者的ESRD发生率(17.3%)高于正常体重患者(13.2%)、超重患者(11.0%)或肥胖者(9.5%)。经多因素COX回归分析，调整人口学特征和临床变量后，体重不足与终末期肾病的风险增加(HR：3.5，95%CI：1.3~9.5，P=0.01)。体重过轻患者的血红蛋白、血尿酸、甘油三酯、胆固醇和淋巴细胞计数均低于正常体重患者。体重指数与血清补体C3呈正相关(r=0.25p<；0.001)。我们的研究发现，体重不足是IgAN患者肾脏疾病进展的独立危险因素，这可能与营养不良状况和C3水平下降有关。
Studies on the relationship between body mass index (BMI) and renal progression in IgA Nephropathy (IgAN) were limited, especially for underweight patients with IgAN. To elucidate the clinical features and effect of underweight on renal function deterioration in this disease, we recruited IgAN patients with diagnostic age ≥18 years old and a baseline estimated glomerular filtration rate (eGFR) ≥15 ml/min/1.73m2 from our center between 1985 and 2014. Patients secondary to systemic diseases or follow-up less than 6 months were excluded. All patients’ clinical data at renal biopsy and during follow-up were recorded. Renal outcome was defined as end-stage kidney disease (ESRD). Baseline body mass index (BMI) was calculated by weight (kg) over squared height (m2). According to WHO Asian guideline, BMI was categorized as follows: <18.5kg/m2 (underweight), 18.5–22.99kg/m2 (normal weight), 23–27.49kg/m2 (overweight) and obese (≥27.5 kg/m2). Of 930 primary IgAN patients enrolled in this study, mean age at renal biopsy was 37.6 years and 49.2% were men. Totally, 114 (12.3%) ESRD occurred after a mean follow-up of 47.1 months. More ESRD happened in underweight patients (17.3%) compared to patients with normal weight (13.2%), overweight (11.0%) or obesity (9.5%). By multivariate Cox regression analysis, underweight was independently associated with a higher risk of ESRD after adjustment for demographic characteristics and clinical variables (HR: 3.5, 95% CI: 1.3–9.5, P = 0.01) comparing to normal weight. Underweight patients had lower hemoglobin, serum uric acid, triglycerides, cholesterol and lymphocyte counts than patients with normal weight. Furthermore, BMI was positively correlated with serum C3 (r = 0.25, p <0.001). Our research finds that underweight is an independent risk factor for kidney disease progression in IgAN, which might be associated with malnutrition status and decreased C3 levels.