Department of Medicine, Stanford University School of Medicine, Palo Alto, California;, Departments of †Epidemiology and Biostatistics and, ‡Medicine, Division of Nephrology, University of California, San Francisco, California, §Geriatrics Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Clin J Am Soc Nephrol. 2013 Oct;8(10):1734-40. doi: 10.2215/CJN.01410213. Epub 2013 Sep 5.
Among patients receiving maintenance dialysis, weight loss at any body mass index is associated with mortality. However, it is not known whether weight changes before dialysis initiation are associated with mortality and if so, what risks are associated with weight gain or loss.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Linking data from the US Renal Data System to a national registry of nursing home residents, this study identified 11,090 patients who started dialysis between January of 2000 and December of 2006. Patients were categorized according to weight measured between 3 and 6 months before dialysis initiation and the percentage change in body weight before dialysis initiation (divided into quintiles). The outcome was mortality within 1 year of starting dialysis.
There were 361 patients (3.3%) who were underweight (Quételet's [body mass] index<18.5 kg/m(2)) and 4046 patients (36.5%) who were obese (body mass index ≥ 30 kg/m(2)) before dialysis initiation. The median percentage change in body weight before dialysis initiation was -6% (interquartile range=-13% to 1%). There were 6063 deaths (54.7%) over 1 year of follow-up. Compared with patients with minimal weight changes (-3% to 3%, quintile 4), patients with weight loss ≥ 15% (quintile 1) had 35% higher risk for mortality (95% confidence interval, 1.25 to 1.47), whereas those patients with weight gain ≥ 4% (quintile 5) had a 24% higher risk for mortality (95% confidence interval, 1.14 to 1.35) adjusted for baseline body mass index and other confounders.
Among nursing home residents, changes in body weight in advance of dialysis initiation are associated with significantly higher 1-year mortality.
在接受维持性透析的患者中，任何体重指数下的体重减轻都与死亡率相关。然而，目前尚不清楚在开始透析之前的体重变化是否与死亡率相关，如果相关，体重增加或减少与哪些风险相关。
设计、设置、参与者和测量方法：通过将美国肾脏数据系统的数据与全国疗养院居民登记处的数据进行链接，本研究确定了 11090 名在 2000 年 1 月至 2006 年 12 月期间开始透析的患者。患者根据透析前 3 至 6 个月测量的体重以及透析前体重变化的百分比（分为五分位数）进行分类。结果是开始透析后 1 年内的死亡率。
在开始透析前，有 361 名患者（3.3%）体重不足（体重指数<18.5kg/m²），4046 名患者（36.5%）肥胖（体重指数≥30kg/m²）。透析前体重变化的中位数百分比为-6%（四分位间距=-13%至 1%）。在 1 年的随访期间，有 6063 例死亡（54.7%）。与体重变化最小（-3%至 3%，五分位 4）的患者相比，体重减轻≥15%（五分位 1）的患者死亡率高 35%（95%置信区间，1.25 至 1.47），而体重增加≥4%（五分位 5）的患者死亡率高 24%（95%置信区间，1.14 至 1.35），调整了基线体重指数和其他混杂因素。
在疗养院居民中，在开始透析之前的体重变化与 1 年死亡率显著相关。
