Malnutrition and atherosclerosis in dialysis patients
Malnutrition and atherosclerosis in dialysis patients
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DOI：
10.1097/01.asn.0000113319.57131.28
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发表时间：
2004-03-01
影响因子：
13.6
通讯作者：
Samore, MH
中科院分区：
文献类型：
--
作者：
Beddhu, S;Pappas, LM;Samore, MH
营养不良与尿毒症患者动脉粥样硬化事件的纵向关联尚不清楚。在美国1995年1月至1999年12月开始透析的50,732例正常（18.5至24.9 kg/m(2)）、低（< 18.5 kg/m(2)）或高（大于或等于25 kg/m(2)）的医疗保险透析患者中，报告测量了肌酐清除率和急性冠脉综合征（ACS；国际疾病分类，第九版修订代码410）。X和411。X)在参数生存模型中进行检验。BMI正常为参照组。24小时尿肌酐（UCr）作为测量肌肉质量的指标。住院ACS事件7213例（14.2%），其中死亡1528例（22%）（30 d内死亡）。急性冠脉综合征后一年死亡率为48%。低BMI[危险比[HR]， 0.89；P = 0.02]与较低的危险相关，在多变量模型中，UCr不能预测住院ACS的发生。低BMI （NS）与住院ACS/疑似院外ACS死亡的复合终点无关，而最低UCr四分位数与较高的危险相关（HR, 1.14; P < 0.001）。低BMI （HR, 1.24, P < 0.001）和UCr降低（最高四分位数参考，第二四分位数HR， 1.11 [P < 0.001]；第三四分位数HR， 1.24 [P < 0.001]；第四四分位数HR， 1.43 [P < 0.001]）与死亡风险增加相关。住院透析患者的ACS事件具有非常高的即时和长期死亡率。营养不良与住院ACS事件的正纵向关联尚未得到证实。进一步的纵向研究有必要提供明确的证据，证明营养不良是动脉粥样硬化的尿毒症危险因素。
Longitudinal associations of malnutrition with atherosclerotic events in uremia are unclear. In 50,732 incident Medicare dialysis patients who had normal (18.5 to 24.9 kg/m(2)), low (< 18.5 kg/m(2)), or high (greater than or equal to 25 kg/m(2)) body mass index (BMI) and initiated dialysis in the United States from January 1995 to December 1999 with reported measured creatinine clearances and acute coronary syndrome (ACS; International Classification of Diseases, Ninth Revision codes 410. x and 411.x) were examined in parametric survival models. Normal BMI was the referent group. Twenty-four-hour urinary creatinine (UCr) was used as a measure Of Muscle mass. There were 7213 (14.2%) hospitalized ACS events, 1528 (22%) of which were fatal (death within 30 d). One-year post-ACS mortality was 48%. Low BMI [hazard ratio [HR], 0.89; P = 0.02] was associated with lower hazard, and UCr was not predictive (NS) of hospitalized ACS in multivariable model. Low BMI (NS) was not associated with a composite end point of hospitalized ACS/suspected out-of-hospital ACS death, whereas lowest UCr quartile was associated with higher hazard (HR, 1.14; P < 0.001). Low BMI (HR, 1.24; P < 0.001) and decrease in UCr (highest quartile reference, second quartile HR, 1.11 [P < 0.001]; third quartile HR, 1.24 [P < 0.001]; and fourth quartile HR, 1.43 [P < 0.001]) were associated with increased hazard of death. Hospitalized ACS events in dialysis patients carry very high immediate and long-term mortality. Positive longitudinal associations of malnutrition with documented hospitalized ACS events Could not be demonstrated. Further longitudinal studies are warranted to provide definitive evidence of malnutrition as a uremic risk factor for atherosclerosis.