Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients
Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients
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DOI：
10.1093/ndt/gfn167
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发表时间：
2008-09-01
影响因子：
6.1
通讯作者：
Dekker, Fniedo W.
中科院分区：
文献类型：
--
作者：
de Mutsert, Renee;Grootendorst, Diana C.;Dekker, Fniedo W.
背景。蛋白质能量消耗（PEW）、炎症和心血管疾病（CVD）明显导致慢性透析患者的高死亡率。我们的目的是研究这三种危险因素与透析患者长期死亡率之间的相互作用。一项前瞻性多中心队列研究纳入了首次接受透析治疗的ESRD患者[荷兰透析充足性合作研究-2 (NECOSAD-II)]，纳入了这些危险因素的完整数据（n = 815，年龄：59 +/- 15岁，60%男性，65% HD）。计算随访7年全因死亡率的风险比（HR）。根据效应的可加性，检验了三种危险因素之间是否存在相互作用。在所有患者中，10%仅患有PEW（7分主观整体评估1-5分），11%患有炎症（CRP >= 10 mg/L）， 14%患有CVD， 22%患有两种成分的任何组合。只有6%的患者同时具备这三种危险因素。皮尤（HR: 1.6, 95% CI: 1.3-2.0）、炎症（1.6,1.3-2.0）或心血管疾病（1.7,1.4-2.1）的患者死亡风险增加。在具有所有三种危险因素的患者中，45/100人年的粗死亡率比考虑到皮尤、炎症和心血管疾病的单独影响后的预期高16人/100人年。相互作用导致的相对过量风险为2.9 (95% CI: 0.3-5.4)，意味着相互作用是加性的。在调整年龄、性别、治疗方式、原发性肾脏疾病、糖尿病和恶性肿瘤后，所有三种危险因素患者的HR为4.8 （95% CI: 3.2-7.2）。同时存在的皮尤、炎症和心血管疾病显著地增加了死亡风险，这意味着皮尤与透析患者的炎症和心血管疾病相互作用。
Background. Protein-energy wasting (PEW), inflammation and cardiovascular diseases (CVD) clearly contribute to the high mortality in chronic dialysis. Our aim was to examine the presence of additive interaction between these three risk factors in their association with long-term mortality in dialysis patients.Methods. Patients from a prospective multi-centre cohort study among ESRD patients starting with their first dialysis treatment [the Netherlands Co-operative Study on the Adequacy of Dialysis-2 (NECOSAD-II)] with complete data on these risk factors were included (n = 815, age: 59 +/- 15 years, 60% men, 65% HD). Hazard ratios (HR) were calculated for all-cause mortality in 7 years of follow-up. The presence of interaction between the three risk factors was examined, based on additivity of effects.Results. Of all patients, 10% only suffered from PEW (1-5 on the 7-point subjective global assessment), 11% from inflammation (CRP >= 10 mg/L), 14% from CVD and 22% had any combination of two components. Only 6% of the patients had all three risk factors. Patients with either PEW (HR: 1.6, 95% CI: 1.3-2.0), inflammation (1.6, 1.3-2.0) or CVD (1.7, 1.4-2.1) had an increased mortality risk. In patients with all three risk factors, the crude mortality rate of 45/100 person-years was 16 deaths/100 person-years higher than expected from the addition of the solo effects of PEW, inflammation and CVD. The relative excess risk due to interaction was 2.9 (95% CI: 0.3-5.4), implying additive interaction. After adjustment for age, sex, treatment modality, primary kidney diseases, diabetes and malignancy the HR for patients with all three risk factors was 4.8 (95% CI: 3.2-7.2).Conclusions. The concurrent presence of PEW, inflammation and CVD increased the mortality risk strikingly more than expected, implying that PEW interacts with inflammation and CVD in dialysis patients.