Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
J Ren Nutr. 2013 Mar;23(2):106-13. doi: 10.1053/j.jrn.2012.04.009. Epub 2012 Jun 26.
To investigate the level of anorexia and its correlation with mortality in chronic kidney disease stage 5 patients not yet on dialysis (CKD5-ND) and in those with stage 5 chronic kidney disease undergoing dialysis (CKD5-D).
In an observational study, self-rated appetite (as part of a subjective global assessment of nutritional status), along with anthropometrics and biochemical markers of nutritional status, was analyzed in relation to survival. In a subgroup of patients, appetite change after start of dialysis was studied prospectively.
Two hundred eighty CKD5-ND (40% female; age 54 ± 12 years; glomerular filtration rate 7 ± 2 mL/minute) and 243 CKD5-D patients (116 hemodialysis and 127 peritoneal dialysis [PD]; 44% female; age 54 ± 12 years; dialysis vintage time 12 ± 2 months) who had been on dialysis for about 1 year were studied.
CKD5-ND patients with poor appetite (50%) had a higher prevalence of cardiovascular disease, lower body weight and serum creatinine level, and higher C-reactive protein. CKD5-D patients with poor appetite (33%) had impaired subjective global assessment of nutritional status and lower body weight, fat body mass, handgrip strength, hemoglobin, and serum albumin level. In a Kaplan-Meier analysis, appetite was not associated with survival difference, whereas in the Cox proportional hazards model with competing risk analysis, poor appetite increased mortality risk in PD patients but not in hemodialysis and CKD5-ND patients.
In CKD5-ND patients, self-rated appetite was not an independent predictor of 48-months survival, whereas there was a significant increase in mortality risk in PD patients with poor appetite.
调查尚未接受透析的慢性肾脏病 5 期（CKD5-ND）患者和接受透析的慢性肾脏病 5 期（CKD5-D）患者的厌食症水平及其与死亡率的相关性。
在一项观察性研究中，分析了自我评估的食欲（作为营养状况总体主观评估的一部分）以及人体测量学和营养状况的生化标志物与生存的关系。在患者亚组中，前瞻性研究了开始透析后食欲的变化。
280 例 CKD5-ND 患者（40%为女性；年龄 54±12 岁；肾小球滤过率 7±2mL/min）和 243 例 CKD5-D 患者（116 例血液透析和 127 例腹膜透析[PD]；44%为女性；年龄 54±12 岁；透析时间 12±2 个月）接受了约 1 年的透析。
食欲不佳（50%）的 CKD5-ND 患者患心血管疾病的比例较高，体重和血清肌酐水平较低，C 反应蛋白较高。食欲不佳（33%）的 CKD5-D 患者营养状况总体主观评估较差，体重、体脂肪量、握力、血红蛋白和血清白蛋白水平较低。在 Kaplan-Meier 分析中，食欲与生存差异无关，但在竞争风险分析的 Cox 比例风险模型中，PD 患者的食欲不佳会增加死亡风险，但血液透析和 CKD5-ND 患者则不会。
在 CKD5-ND 患者中，自我评估的食欲不是 48 个月生存的独立预测因素，而 PD 患者食欲不佳的死亡风险显著增加。
