Yen Tzung-Hai, Lin Ja-Liang, Lin-Tan Dan-Tzu, Hsu Ching-Wei
Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Ther Apher Dial. 2010 Aug 1;14(4):400-8. doi: 10.1111/j.1744-9987.2010.00818.x.
A total of 959 Taiwanese patients undergoing maintenance hemodialysis-102 underweight (BMI < 18.5 kg/m(2)), 492 normal weight (BMI 18.5-22.9 kg/m(2)), 187 overweight (BMI 23.0-24.9 kg/m(2)), and 178 obese (BMI >or= 25 kg/m(2)) were recruited into this three-year, multicenter longitudinal study. It was found initially that the underweight group had more females, longer hemodialysis durations, less use of a biocompatible membrane (BCM) dialyzer, higher erythropoietin doses and Kt/V(urea), and lower white blood cell counts, hemoglobin, serum creatinine and phosphate, and high sensitivity C-reactive protein (hsCRP) than other groups (P < 0.001). Furthermore, a chi(2)-test demonstrated that underweight patients had poorer nutrition (P = 0.023), but less systemic inflammation (P < 0.001) than other groups. A stepwise multiple linear regression analysis established that age, sex, diabetes mellitus, hemodialysis duration, use of BCM dialyzer, Kt/V(urea), creatinine, high-density lipoprotein cholesterol, and hsCRP were significant risk factors associated with BMI (P < 0.001-0.002). After three years, 149 (15.5%) patients had died, including 22 of 102 (21.6%) underweight patients, 64 of 492 (13.0%) normal weight patients, 38 of 187 (20.3%) overweight patients, and 25 of 178 (15.5%) obese patients. The primary causes of mortality were cardiovascular (52.3%) and infection (39.6%). A multivariate Cox regression analysis revealed that age, diabetes mellitus, BMI, albumin, hsCRP, and cardiothoracic ratio were significant risk factors associated with all-cause mortality over three years (P < 0.001-0.022). Finally, Kaplan-Meier analysis confirmed that underweight patients suffer higher mortality than other groups (Log rank, P = 0.0392); therefore, the data have demonstrated a survival disadvantage of low BMI in Taiwanese patients undergoing maintenance hemodialysis.
共有959名接受维持性血液透析的台湾患者被纳入这项为期三年的多中心纵向研究，其中102人体重过轻（体重指数<18.5kg/m²），492人体重正常（体重指数18.5 - 22.9kg/m²），187人超重（体重指数23.0 - 24.9kg/m²），178人肥胖（体重指数≥25kg/m²）。最初发现，体重过轻组女性更多，血液透析时间更长，生物相容性膜（BCM）透析器使用较少，促红细胞生成素剂量和尿素清除率（Kt/V）更高，白细胞计数、血红蛋白、血清肌酐和磷酸盐以及高敏C反应蛋白（hsCRP）低于其他组（P<0.001）。此外，卡方检验表明，体重过轻的患者营养状况较差（P = 0.023），但全身炎症反应低于其他组（P<0.001）。逐步多元线性回归分析确定，年龄、性别、糖尿病、血液透析时间、BCM透析器的使用、Kt/V（尿素）、肌酐、高密度脂蛋白胆固醇和hsCRP是与体重指数相关的显著危险因素（P<0.001 - 0.002）。三年后，149名（15.5%）患者死亡，其中102名体重过轻患者中有22名（21.6%），492名体重正常患者中有64名（13.0%），187名超重患者中有38名（20.3%），178名肥胖患者中有25名（15.5%）。死亡的主要原因是心血管疾病（52.3%）和感染（39.6%）。多变量Cox回归分析显示，年龄、糖尿病、体重指数、白蛋白、hsCRP和心胸比是与三年全因死亡率相关的显著危险因素（P<0.001 - 0.022）。最后，Kaplan - Meier分析证实体重过轻的患者死亡率高于其他组（对数秩检验，P = 0.0392）；因此，数据表明台湾接受维持性血液透析的患者中低体重指数存在生存劣势。
