Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
Am J Transplant. 2011 Apr;11(4):725-36. doi: 10.1111/j.1600-6143.2011.03468.x.
A body mass index (BMI) below morbid obesity range is often a requirement for kidney transplant wait-listing, but data linking BMI changes to mortality during the waitlist period are lacking. By linking the 6-year (7/2001-6/2007) national databases of a large dialysis organization and the Scientific Registry of Transplant Recipients, we identified 14 632 waitlisted hemodialysis patients without kidney transplantation. Time-dependent survival models examined the mortality predictability of 13-week-averaged BMI, pretransplant serum creatinine as a muscle mass surrogate and their changes over time. The patients were on average 52 ± 13 years old, 40% women and had a BMI of 26.9 ± 6.3 kg/m². Each kg/m² increase of BMI was associated with a death hazard ratio (HR) of 0.96 (95%CI: 0.95-0.97). Compared to the lowest creatinine quintile, the 4th and 5th quintiles had death HRs of 0.75 (0.66-0.86) and 0.57 (0.49-0.66), respectively. Compared to minimal (< ± 1 kg) weight change over 6 months, those with 3 kg- < 5 kg and ≥ 5 kg weight loss had death HRs of 1.31 (1.14-1.52) and 1.51 (1.30-1.75), respectively. Similar associations were observed with creatinine changes over time. Transplant-waitlisted hemodialysis patients with lower BMI or muscle mass and/or unintentional weight or muscle loss have higher mortality in this observational study. Impact of intentional weight change remains unclear.
身体质量指数（BMI）低于病态肥胖范围通常是肾移植候补名单的要求，但缺乏将 BMI 变化与候补期间死亡率相关联的数据。通过将大型透析组织的 6 年（2001 年 7 月-2007 年 6 月）国家数据库与移植受者科学登记处相链接，我们确定了 14632 名未接受肾移植的候补血液透析患者。时间依赖性生存模型检查了 13 周平均 BMI、移植前血清肌酐作为肌肉质量替代物及其随时间变化的死亡率预测能力。患者平均年龄为 52 ± 13 岁，40%为女性，BMI 为 26.9 ± 6.3kg/m²。BMI 每增加 1kg/m²，死亡风险比（HR）为 0.96（95%CI：0.95-0.97）。与肌酐最低五分位数相比，第 4 五分位数和第 5 五分位数的死亡 HR 分别为 0.75（0.66-0.86）和 0.57（0.49-0.66）。与 6 个月期间体重变化最小（<±1kg）相比，体重减轻 3kg-<5kg 和≥5kg 的死亡 HR 分别为 1.31（1.14-1.52）和 1.51（1.30-1.75）。随着时间的推移，肌酐变化也观察到类似的关联。在这项观察性研究中，BMI 或肌肉量较低且/或非故意体重或肌肉损失的移植候补血液透析患者死亡率较高。有意改变体重的影响仍不清楚。
