The joint association of malnutrition and activities of daily living dependence with adverse health outcomes among patients initiating maintenance dialysis
The joint association of malnutrition and activities of daily living dependence with adverse health outcomes among patients initiating maintenance dialysis
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开始维持性透析的患者营养不良和日常生活依赖活动与不良健康结果的联合关联
DOI：
10.1016/j.clnu.2022.05.012
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发表时间：
2022
影响因子：
6.3
通讯作者：
Meng Wei
中科院分区：
文献类型：
--
作者：
Limin Wei;Fanfan Gao;Lei Chen;Jie Li;Xue Zhao;Ning Qu;Xinmei Huang;Hongli Jiang;Meng Wei
虽然之前的工作已经分别研究了日常生活活动（ADL）依赖和营养不良，但这些条件的累加效应仍然不确定。因此，本研究的目的是评估营养不良和 ADL 依赖与透析患者不良健康结果的联合关联。新进入透析患者预后的爱知队列研究数据库中的 1457 名患者被确定纳入这项纵向研究。采用老年营养风险指数和Barthel指数作为营养状况和功能能力的评价工具。营养不良和 ADL 依赖的组合分类由四个亚组生成。分别使用 Cox 比例风险模型和竞争风险生存模型研究了这些暴露与健康结果（包括全因死亡率、主要不良心血管事件 (MACE) 和感染相关死亡）之间的关联。39.5% 的参与者没有营养不良或 ADL 依赖（正常），30.3% 营养不良，10.5% 依赖 ADL，19.8% 既营养不良又营养不良 和 ADL 依赖。在 4752 人年的随访中，367 人（25.2%）死亡，650 人（44.6%）患者遭受 MACE。与参考组（ADL 依赖和无营养不良）相比，营养不良/ADL 依赖组合与全因死亡（完全调整 HR 2.64，95% CI 1.79-3.89）、感染死亡率（完全调整 HR 4.41，95% CI 1.88-10.40）和 MACE 发生率（完全调整 HR 1.81，95% CI 1.79-3.89）的相关性最强。 95% CI 1.36-2.42）。在几个亚组和敏感性分析中，这种关系仍然可信且稳健。此外，我们发现这种关联在 75 岁及以上的患者中更高。在开始透析时同时存在营养不良和 ADL 依赖会产生显着的不利影响。
While prior work has examined activities of daily living (ADL) dependence and malnutrition separately, the additive effects of these conditions remain uncertain. Therefore, the purpose of this study was to evaluate the joint association of malnutrition and ADL dependence with poor health outcomes in incident dialysis patients.1457 patients from the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis database were identified for inclusion in this longitudinal study. The geriatric nutritional risk index and Barthel index were used as the evaluation tool for nutritional status and functional ability. Combined classifications of malnutrition and ADL dependence were generated with four subgroups derived. Associations between these exposures and health outcomes, including all-cause mortality, major adverse cardiovascular events (MACE), and infection-related death were investigated using Cox-proportional hazard models and competing risk survival models, respectively.39.5% of the participants were not malnourished nor ADL dependent (normal), 30.3% were malnourished, 10.5% ADL dependent and 19.8% as having both malnutrition and ADL dependence. During 4752 person-years of follow-up, 367 (25.2%) died and 650 (44.6%) patients suffered a MACE. Compared with the reference group (ADL dependency and no-malnutrition), the combination malnourished/ADL dependent showed the strongest association with all cause death (fully-adjusted HR 2.64, 95% CI 1.79-3.89), mortality from infection (fully-adjusted HR 4.41, 95% CI 1.88-10.40), and MACE incidence (fully-adjusted HR 1.81, 95% CI 1.36-2.42). This relationship remained credible and robust in several subgroup and sensitivity analyses. Additionally, we identified this associations were higher in patients aged 75 and older.The concurrent presence of malnutrition and ADL dependence at the time of dialysis initiation has significant detrimental impacts.