Fujino Yoko, Ishimura Eiji, Okuno Senji, Tsuboniwa Naoki, Maekawa Kiyoshi, Izumotani Tsuyoshi, Yamakawa Tomoyuki, Inaba Masaaki, Nishizawa Yoshiki
Shirasagi Hospital Kidney Center, Osaka, Japan.
Biomed Pharmacother. 2006 Jun;60(5):253-7. doi: 10.1016/j.biopha.2006.04.001. Epub 2006 May 24.
Although obesity confers an increased risk of mortality in the general population, it has been reported to be associated with improved survival in dialysis patients. However, the influence of fat mass change over time on mortality in dialysis patients has not been determined.
This relationship was examined in 190 female maintenance hemodialysis patients. Fat mass was measured twice with a 12-month interval, using dual energy X-ray absorptiometry (DEXA). The patients were followed up for 5 years, and predictors for all-cause death were examined using Kaplan-Meier analysis and Cox proportional hazards analyses.
During the 5-year follow-up period, 65 patients died. Annual fat mass changes in the expired group tended to be greater than in the surviving group (-1.0 +/- 2.5 vs. -0.3 +/- 2.6 kg; P = 0.0776), although initial body fat mass was not significantly different. Kaplan-Meier analysis revealed that patients with decreased fat mass (N = 110) had a significantly lower survival rate, compared with those with increased fat mass (N = 80; P = 0.021). Multivariate Cox proportional hazards analyses demonstrated that annual fat mass change was a significant predictor of all-cause mortality after adjustments for confounding factors, such as age, serum albumin, serum creatinine, and the presence of diabetes. An increase in annual fat mass of 1 kg reduced mortality by 14.5%.
These results demonstrate that the decrease in annual fat mass is a significant predictor for mortality in female hemodialysis patients. Fat mass change is also a useful parameter for measurement of nutritional status in hemodialysis patients.
尽管肥胖在普通人群中会增加死亡风险，但据报道在透析患者中肥胖与生存率提高有关。然而，脂肪量随时间的变化对透析患者死亡率的影响尚未确定。
在190名维持性血液透析的女性患者中研究了这种关系。使用双能X线吸收法（DEXA），间隔12个月对脂肪量进行了两次测量。对患者进行了5年的随访，并使用Kaplan-Meier分析和Cox比例风险分析检查了全因死亡的预测因素。
在5年的随访期内，65名患者死亡。尽管初始体脂量没有显著差异，但死亡组的年脂肪量变化倾向于大于存活组（-1.0±2.5 vs. -0.3±2.6 kg；P = 0.0776）。Kaplan-Meier分析显示，脂肪量减少的患者（N = 110）与脂肪量增加的患者相比，生存率显著更低（N = 80；P = 0.021）。多变量Cox比例风险分析表明，在对年龄、血清白蛋白、血清肌酐和糖尿病等混杂因素进行调整后，年脂肪量变化是全因死亡率的显著预测因素。年脂肪量增加1 kg可使死亡率降低14.5%。
这些结果表明，年脂肪量减少是女性血液透析患者死亡率的显著预测因素。脂肪量变化也是衡量血液透析患者营养状况的一个有用参数。
