A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients.
A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients.
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DOI：
10.1186/s12882-015-0110-9
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发表时间：
2015-07-22
期刊：
影响因子：
2.3
通讯作者：
Stefánsson BV
中科院分区：
文献类型：
--
作者：
Cabrera C;Brunelli SM;Rosenbaum D;Anum E;Ramakrishnan K;Jensen DE;Stålhammar NO;Stefánsson BV
较大的透析间期体重增加(IDWG)与全因死亡率和住院风险相关。与非肾脏疾病患者相比，透析患者发生心血管事件的风险也更大。这项回顾研究考察了IDWG和特定类型的心血管事件之间的潜在关联。数据来自美国肾脏数据系统索赔和2007年1月1日至2008年12月31日期间在一家大型透析组织启动血液透析的医疗保险患者的电子健康记录。绝对IDWG定义为透析前体重减去先前治疗的透析后体重，相对IDWG计算为透析后体重的百分比及其平均值，计算时间为91至180天。患者结局被认为从第181天开始，一直持续到死亡、停止护理、审查或研究结束(2009年12月31日)。结果包括全因死亡率、心血管死亡率、非致命性心力衰竭/容量超负荷住院、非致命性心肌梗死住院、MACE(非致命性心肌梗死、非致命性缺血性中风或心血管死亡的综合衡量标准)和MACE+(包括MACE以及心律失常、非致命性出血性中风或心力衰竭住院)。IDWG与暴露期间的结果之间的关联使用比例风险回归进行了估计，并根据基线特征进行了调整。39,256名患者符合分析条件。总体而言，相对IDWG与结果的关联比绝对IDWG更有效、更一致、更单调。IDWG >； 3.5%的相对体重与所有研究结果独立相关：点估计值从1.18点(心肌梗死)到1.26点(心血管死亡率)，在有和不有糖尿病、有或不有基线心力衰竭的患者中是一致的。IDWG >； 3千克绝对值与心肌梗死以外的其他预后相关：积分估计值从1.11(MACE)到1.20(心力衰竭)。IDWG越大，发生心血管病态事件的风险越高。减轻IDWG的策略可能会改善血液透析患者的心血管健康和存活率。
Greater interdialytic weight gain (IDWG) is associated with risk of all-cause mortality and hospitalization. Dialysis patients are also at greater risk of cardiovascular (CV) events than patients without kidney disease. This retrospective study examined the potential association between IDWG and specific types of CV events. Data were obtained from United States Renal Data System claims and the electronic health records of Medicare patients who initiated hemodialysis between 01 January 2007 and 31 December 2008 at a large dialysis organization. Absolute IDWG was defined as predialysis weight minus postdialysis weight from the prior treatment, and relative IDWG was calculated as percentage of postdialysis weight with mean values for each, calculated over dialysis days 91 to 180. Patient outcomes were considered beginning on day 181, continuing until death, discontinuation of care, censoring, or study end (31 December 2009). Outcomes included all-cause mortality, CV mortality, hospitalization for nonfatal heart failure/volume overload, hospitalization for nonfatal myocardial infarction, MACE (a composite measure of nonfatal myocardial infarction, nonfatal ischemic stroke, or CV death), and MACE+ (events comprising MACE as well as arrhythmia, nonfatal hemorrhagic stroke, or hospitalization for heart failure). Associations between IDWG and outcomes over the exposure period were estimated using proportional hazards regression and adjusted for baseline characteristics. 39,256 patients qualified for analysis. In general, associations of relative IDWG with outcomes were more potent, consistent, and monotonic than those for absolute IDWG. Relative IDWG > 3.5 % body weight was independently associated with all outcomes studied: point estimates ranged from 1.18 (myocardial infarction) to 1.26 (CV mortality) and were consistent among patients with and without diabetes, and with and without baseline heart failure. Absolute IDWG > 3 kg was associated with outcomes other than myocardial infarction: point estimates ranged from 1.11 (MACE) to 1.20 (heart failure). Greater IDWG is associated with an increased risk of CV morbid events. Strategies that mitigate IDWG may improve CV health and survival among hemodialysis patients.