The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis
The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis
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DOI：
10.4065/mcp.2010.0336
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发表时间：
2010-11-01
影响因子：
8.9
通讯作者：
Anker, Stefan D.
中科院分区：
文献类型：
--
作者：
Kalantar-Zadeh, Kamyar;Streja, Elani;Anker, Stefan D.
目的确定干体重增加伴肌肉质量增加是否与接受维持性血液透析（HD）患者的生存获益相关。患者和方法在一个全国代表性的5年队列中，121，762例患者从2001年7月1日至2006年6月30日每周接受3次HD，我们检查了体重指数（BMI）（使用HD后3个月平均干重计算）和3个月平均血清肌酐水平（肌肉质量的可能替代品）及其随时间的变化预测了死亡风险。BMI较高（高达45）和更高的血清肌酐浓度与更高的生存率递增和独立相关，即使在对营养状态和炎症的可用替代物进行广泛的多变量调整后，干体重随时间的减轻或增加分别与更高的死亡率或生存率分级相关，血清肌酸酐水平随时间的变化也是如此。在前6个月存活并且具有体重和肌酸酐水平变化的可用数据的50，831名患者中，那些体重减轻但血清肌酐水平升高的人比那些体重增加但肌酐水平降低的人有更高的生存率。接受HD的患者的人口统计学分组结论在接受长期HD的患者中，较大的体型和更多的肌肉质量似乎与较高的生存率相关。随着时间的推移，体重减轻的不一致肌肉增加可能比体重增加而肌肉减少带来更多的生存益处。
OBJECTIVE To determine whether dry weight gain accompanied by an increase In muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD)PATIENTS AND METHODS in a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post HD dry weight) and 3 month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality riskRESULTS in the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and Independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level These associations appeared consistent across different demographic groups of patients receiving HDCONCLUSION in patients receiving long term HD, larger body size with more muscle mass appears associated with a higher survival rate A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle Controlled trials of muscle-gaining interventions in patients receiving HD are warranted