Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy
Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy
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DOI：
10.1007/s00134-010-1844-2
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发表时间：
2010-07-01
影响因子：
38.9
通讯作者：
Metnitz, Philipp G. H.
中科院分区：
文献类型：
--
作者：
Druml, Wilfred;Metnitz, Barbara;Metnitz, Philipp G. H.
在慢性肾脏疾病患者中，随着体重的增加，生存率更高，这一观察结果被称为“肥胖悖论”。为了研究急性肾损伤（阿基）患者是否也存在这种影响，我们分析了体重对需要肾脏替代治疗的重症阿基患者预后的影响。我们分析了来自53个奥地利ICU的5，232名需要肾脏替代治疗的阿基患者。患者被分为5个BMI组之一：体重不足、正常、超重、肥胖和病态肥胖。阿基的发生率随着体重的增加而增加，从体重不足，正常（5.4%）到病态肥胖（11.8%）。此外，所有组发生阿基的校正比值比均显著增加（参考组：正常）。风险调整后的住院死亡率呈U型，肥胖患者的死亡率最低（BMI为千分之一日元30 < 35）。多变量分析（调整了疾病严重程度、性别、入院原因和合并症）证实了这些结果：肥胖患者在医院死亡的概率显著降低[比值比0.81（0.66-0.98）]。肥胖是发生阿基的独立风险因素。我们的研究结果提供了进一步的证据，表明体重影响需要肾脏替代治疗的阿基患者的生存率。与体重不足或正常体重的患者相比，肥胖患者似乎有生存益处。
In patients with chronic kidney disease, survival has been shown to be better with increasing body mass, an observation which was termed the "obesity paradox". To investigate if such an effect would also be present in patients with acute kidney injury (AKI), we analysed the impact of body mass on the prognosis of intensive care patients with severe AKI requiring renal replacement therapy.A total of 5,232 patients with AKI requiring renal replacement therapy from 53 Austrian ICUs were analysed.Patients were divided into one of five BMI groups: underweight, normal, overweight, obese and morbid obese. The incidence of AKI increased with increasing body mass from underweight, normal (5.4%) to morbid obese (11.8%). Moreover, adjusted odds ratios to develop AKI were significantly increased for all groups (reference group: normal). Risk-adjusted hospital mortality rates followed a U-shaped pattern, with the lowest mortality in obese patients (BMI of a parts per thousand yen 30 < 35). Multivariate analysis (with adjustment for severity of illness, sex, reason for admission and comorbidities) confirmed these results: obese patients presented with a significantly reduced probability to die in the hospital [odds ratio 0.81 (0.66-0.98)].Obesity is an independent risk factor for developing AKI. Our results provide further evidence that body mass impacts on survival of patients with AKI requiring renal replacement therapy. Obese patients seem to have a survival benefit compared to underweight or normal weight patients.