Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509-2910, USA.
Mayo Clin Proc. 2010 Nov;85(11):991-1001. doi: 10.4065/mcp.2010.0336.
To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD).
In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk.
In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD.
In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted.
确定接受维持性血液透析（HD）治疗的患者，干体重增加伴随肌肉量增加是否与生存获益相关。
在 2001 年 7 月 1 日至 2006 年 6 月 30 日期间接受每周 3 次 HD 治疗的全国代表性的 5 年队列中，共有 121762 例患者，我们检测了体质指数（BMI）（使用 HD 后 3 个月平均干体重计算得出）和 3 个月平均血清肌酐水平（可能是肌肉量的替代指标）及其随时间的变化是否与死亡风险相关。
在队列中，较高的 BMI（最高达 45）和较高的血清肌酐浓度与更高的生存率呈递增且独立相关，即使在对营养状况和炎症的现有替代指标进行广泛的多变量调整后也是如此。随时间推移，干体重的增减与更高的死亡率或生存率呈分级相关，血清肌酐水平随时间的变化也是如此。在存活了前 6 个月且体重和肌酐水平变化数据可用的 50831 例患者中，那些体重减轻但血清肌酐水平升高的患者的生存率高于那些体重增加但肌酐水平降低的患者。这些关联在接受 HD 治疗的不同人群中似乎是一致的。
在接受长期 HD 治疗的患者中，较大的体型和更多的肌肉量似乎与更高的生存率相关。随时间推移出现的体重减轻伴肌肉增加的不一致可能比体重增加伴肌肉减少带来更大的生存获益。有必要对接受 HD 治疗的患者进行增加肌肉的干预措施的对照试验。
