Schmidt Darren S, Salahudeen Abdulla K
Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Semin Dial. 2007 Nov-Dec;20(6):486-92. doi: 10.1111/j.1525-139X.2007.00349.x.
Since the original description of the obesity-survival paradox in 1999, which suggested a survival advantage for overweight and obese patients undergoing hemodialysis, a large body of evidence supporting the paradox has accumulated. The reason for the paradox has yet to be defined. Better nutrition may be a partial explanation, or it may be that in uremic milieu, excessive fat and surplus calories might confer some survival advantage. The "surplus calorie theory" as a potential mechanism for the paradox is of great interest. If proven to be correct, it might explain why peritoneal dialysis patients who receive excessive calories through dialysis do not exhibit the paradox and, secondly and more importantly, therapy could be directed to enhance a greater caloric intake by renal failure patients to engender a better survival outcome. Finally, other clinical settings, for example, congestive heart failure, have their own obesity-survival paradox. Thus, the paradox appears to be a wider phenomenon and might merely be the external expression of a larger principle yet to be uncovered.
自1999年首次描述肥胖-生存悖论以来，该悖论表明接受血液透析的超重和肥胖患者具有生存优势，大量支持该悖论的证据不断积累。该悖论的原因尚未明确。营养状况较好可能是部分原因，也可能是在尿毒症环境中，过多的脂肪和过剩的热量可能带来一些生存优势。作为该悖论潜在机制的“过剩热量理论”备受关注。如果被证明是正确的，它可能解释为什么通过透析摄入过多热量的腹膜透析患者没有出现该悖论，其次且更重要的是，治疗可以针对增加肾衰竭患者的热量摄入以获得更好的生存结果。最后，其他临床情况，例如充血性心力衰竭，也有其自身的肥胖-生存悖论。因此，该悖论似乎是一个更广泛的现象，可能仅仅是一个尚未被发现的更大原则的外在表现。
