Ramkumar Nirupama, Pappas Lisa M, Beddhu Srinivasan
Renal Section, Salt Lake VA Healthcare System, Utah, USA.
Perit Dial Int. 2005 Sep-Oct;25(5):461-9.
Using 24-hour urinary creatinine excretion as a measure of muscle mass, we examined whether body composition influences the survival of incident peritoneal dialysis (PD) patients. We hypothesized that patients with high body mass index (BMI) and low muscle mass might be considered to have high levels of body fat.
Using serum creatinines and creatinine clearances reported on Medical Evidence Form 2728, 24-hour urinary creatinine was calculated in 10 140 incident PD patients with normal (18.5 - 24.9 kg/m2) or high (> or = 25 kg/m2) BMI. Patients were classified as low and normal/high muscle mass groups based on the 25th percentile of 24-hour urinary creatinine (0.64 g/day).
In multivariable parametric survival models, compared to the normal BMI-normal/high muscle mass patients, high BMI-normal/high muscle mass patients had lower hazard of all-cause [hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.83 - 0.97] and cardiovascular (HR 0.88, 95% CI 0.79 - 0.97) death; high BMI patients with low muscle mass had higher hazard of all-cause (HR 1.29, 95% CI 1.17 - 1.42) and cardiovascular (HR 1.21, 95% CI 1.06 - 1.39) death.
Both body size and body composition influence survival of incident PD patients. As incident PD patients with high BMI and normal or high muscle mass have the best survival, PD patients should be encouraged to gain muscle mass rather than fat mass.
我们以24小时尿肌酐排泄量作为肌肉量的衡量指标，研究了身体组成对新发腹膜透析（PD）患者生存率的影响。我们假设体重指数（BMI）高且肌肉量低的患者可能被认为体脂水平较高。
利用医疗证据表2728上报告的血清肌酐和肌酐清除率，计算了10140例BMI正常（18.5 - 24.9kg/m²）或高（≥25kg/m²）的新发PD患者的24小时尿肌酐。根据24小时尿肌酐的第25百分位数（0.64g/天），将患者分为低肌肉量组和正常/高肌肉量组。
在多变量参数生存模型中，与BMI正常-正常/高肌肉量患者相比，BMI高-正常/高肌肉量患者全因死亡[风险比（HR）0.90，95%置信区间（CI）0.83 - 0.97]和心血管死亡（HR 0.88，95%CI 0.79 - 0.97）的风险较低；BMI高且肌肉量低的患者全因死亡（HR 1.29，95%CI 1.17 - 1.42）和心血管死亡（HR 1.21，95%CI 1.06 - 1.39）的风险较高。
体型和身体组成均影响新发PD患者的生存率。由于BMI高且肌肉量正常或高的新发PD患者生存率最佳，应鼓励PD患者增加肌肉量而非脂肪量。
