Lu Jun Ling, Kalantar-Zadeh Kamyar, Ma Jennie Z, Quarles L Darryl, Kovesdy Csaba P
Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;
Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California;
J Am Soc Nephrol. 2014 Sep;25(9):2088-96. doi: 10.1681/ASN.2013070754. Epub 2014 Mar 20.
Obesity is associated with higher mortality in the general population, but this association is reversed in patients on dialysis. The nature of the relationship of obesity with adverse clinical outcomes in nondialysis-dependent CKD and the putative interaction of the severity of disease with this association are unclear. We analyzed data from a nationally representative cohort of 453,946 United States veterans with eGFR<60 ml/min per 1.73 m(2). The associations of body mass index categories (<20, 20 to <25, 25 to <30, 30 to <35, 35 to <40, 40 to <45, 45 to <50, and ≥50 kg/m(2)) with all-cause mortality and disease progression (using multiple definitions, including incidence of ESRD, doubling of serum creatinine, and the slopes of eGFR) were examined in Cox proportional hazards models and logistic regression models. Multivariable adjustments were made for age, race, comorbidities and medications, and baseline eGFR. Body mass index showed a relatively consistent U-shaped association with clinical outcomes, with the best outcomes observed in overweight and mildly obese patients. Body mass index levels <25 kg/m(2) were associated with worse outcomes in all patients, independent of severity of CKD. Body mass index levels ≥35 kg/m(2) were associated with worse outcomes in patients with earlier stages of CKD, but this association was attenuated in those patients with eGFR<30 ml/min per 1.73 m(2). Thus, until clinical trials establish the ideal body mass index, a cautious approach to weight management is warranted in this patient population.
肥胖与普通人群的较高死亡率相关，但在透析患者中这种关联却相反。肥胖与非透析依赖型慢性肾脏病不良临床结局之间关系的本质，以及疾病严重程度与这种关联之间的假定相互作用尚不清楚。我们分析了来自美国453946名估算肾小球滤过率（eGFR）<60 ml/（min·1.73 m²）的退伍军人的全国代表性队列数据。在Cox比例风险模型和逻辑回归模型中，研究了体重指数类别（<20、20至<25、25至<30、30至<35、35至<40、40至<45、45至<50以及≥50 kg/m²）与全因死亡率和疾病进展（使用多种定义，包括终末期肾病的发病率、血清肌酐翻倍以及eGFR的斜率）之间的关联。对年龄、种族、合并症和药物治疗以及基线eGFR进行了多变量调整。体重指数与临床结局呈现出相对一致的U形关联，超重和轻度肥胖患者的结局最佳。体重指数<25 kg/m²与所有患者的较差结局相关，与慢性肾脏病的严重程度无关。体重指数≥35 kg/m²与早期慢性肾脏病患者的较差结局相关，但在估算肾小球滤过率<30 ml/（min·1.73 m²）的患者中这种关联减弱。因此，在临床试验确定理想的体重指数之前，对该患者群体进行谨慎的体重管理是必要的。
