Nishizawa Yoshiki, Shoji Tetsuo, Ishimura Eiji
Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Ren Nutr. 2006 Jul;16(3):241-4. doi: 10.1053/j.jrn.2006.04.016.
Death rate is unacceptably elevated in end-stage renal disease patients treated with hemodialysis. Excessive body fat, or obesity, is the well-known risk factor for cardiovascular disease and other health problems in the general population. However, hemodialysis patients with a higher body mass index (BMI) have a lower risk of death, as shown by many studies. There are several explanations for the paradox of BMI in dialysis patients. First, although body mass is composed of fat mass and fat-free mass (lean mass), it is unknown which is more important, fat mass or lean mass, in predicting outcome of hemodialysis patients. Second, it is also possible that functions of adipose tissue are altered in renal failure so that accumulation of body fat leads to less atherogenicity and beneficial properties become predominant. Third, an increased fat mass may be protective against death after harmful events. In this article, we explore these possibilities using either the data of our own cohort of hemodialysis patients or the existing registry data of Japan. We conclude that in hemodialysis patients, fat mass rather than lean mass plays a protective role against mortality, that the fat mass-adipocytokine relationship is altered, and that a low BMI is associated with increased risk of fatality after cardiovascular events rather than the risk of occurrence of such events.
接受血液透析治疗的终末期肾病患者死亡率高得令人难以接受。在普通人群中，过多的体脂或肥胖是众所周知的心血管疾病及其他健康问题的风险因素。然而，许多研究表明，体重指数（BMI）较高的血液透析患者死亡风险较低。对于透析患者中BMI的这种矛盾现象有多种解释。首先，尽管体重由脂肪量和去脂体重（瘦体重）组成，但在预测血液透析患者的预后时，脂肪量和瘦体重哪个更重要尚不清楚。其次，也有可能是肾衰竭时脂肪组织的功能发生了改变，因此体脂的积累导致动脉粥样硬化性降低，有益特性占主导。第三，脂肪量增加可能对有害事件后的死亡具有保护作用。在本文中，我们使用我们自己的血液透析患者队列数据或日本现有的登记数据来探讨这些可能性。我们得出结论，在血液透析患者中，脂肪量而非瘦体重对死亡率起保护作用，脂肪量与脂肪细胞因子的关系发生了改变，低BMI与心血管事件后死亡风险增加有关，而非与此类事件的发生风险有关。
