Huang Wen-Hung, Chen Chao-Yu, Lin Ja-Liang, Lin-Tan Dan-Tzu, Hsu Ching-Wei, Yen Tzung-Hai
Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center (WHH, CYC, JLL, DTLT, CWH, THY); and Chang Gung University and School of Medicine (WHH, CYC, JLL, DTLT, CWH, THY), Taoyuan, Taiwan, Republic of China (ROC).
Medicine (Baltimore). 2014 Aug;93(7):e41. doi: 10.1097/MD.0000000000000041.
Whether high body mass index (BMI) has an effect on progressive diabetic nephropathy in type II diabetes mellitus (DM) patients with chronic kidney disease (CKD) stage 3 or 4 remains unclear. This prospective study aimed to investigate the relationship between BMI and progression of renal function deterioration in type II DM patients with CKD stage 3 or 4.A total of 105 type II DM patients with CKD stage 3 or 4 participated in this 24-month prospective observational study. Patients were divided into 3 groups according to BMI as follows: normal group, BMI of 18.5-22.9 kg/m; overweight group, BMI of 23-24.9 kg/m; and obese group, BMI of ≥25 kg/m. The primary end point was a 2-fold elevation in serum creatinine levels (measured twice with a 1-month interval) from baseline values, need for long-term dialysis, or death during the 24-month observation period.In the linear regression analysis with the stepwise method, each 1 kg/m increase in BMI led to an increase of 0.32 mL min × 1.73 m in the estimated glomerular filtration rate (95% confidence interval, CI, 0.01-0.62; P = 0.04) during the 24-month study period. Moreover, multivariate Cox regression analysis showed that compared with the obese group, the normal BMI group (hazard ratio = 2.76, 95% CI : 1.27-6; P = 0.01) achieved the primary outcome after adjusting for other factors.In this 24-month prospective observational study, we showed that BMI of ≥25 kg/m was a protective factor for renal function deterioration in type II DM patients with CKD stage 3 or 4.
在患有慢性肾脏病(CKD)3期或4期的II型糖尿病(DM)患者中,高体重指数(BMI)是否会对糖尿病肾病进展产生影响仍不清楚。这项前瞻性研究旨在调查患有CKD 3期或4期的II型糖尿病患者的BMI与肾功能恶化进展之间的关系。共有105例患有CKD 3期或4期的II型糖尿病患者参与了这项为期24个月的前瞻性观察研究。患者根据BMI分为3组,如下:正常组,BMI为18.5 - 22.9 kg/m²;超重组,BMI为23 - 24.9 kg/m²;肥胖组,BMI≥25 kg/m²。主要终点是在24个月观察期内血清肌酐水平较基线值升高2倍(间隔1个月测量两次)、需要长期透析或死亡。在采用逐步法的线性回归分析中,在24个月的研究期间,BMI每增加1 kg/m²导致估计肾小球滤过率增加0.32 mL·min⁻¹×1.73 m²(95%置信区间,CI,0.01 - 0.62;P = 0.04)。此外,多变量Cox回归分析表明,在调整其他因素后,与肥胖组相比,正常BMI组(风险比 = 2.76,95% CI:1.27 - 6;P = 0.01)达到了主要结局。在这项为期24个月的前瞻性观察研究中,我们表明BMI≥25 kg/m²是患有CKD 3期或4期的II型糖尿病患者肾功能恶化的保护因素。