Shapiro Bryan B, Streja Elani, Ravel Vanessa A, Kalantar-Zadeh Kamyar, Kopple Joel D
Harold Simmons Center for Kidney Disease Research and Epidemiology and Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California;
Harold Simmons Center for Kidney Disease Research and Epidemiology and.
Clin J Am Soc Nephrol. 2015 Jun 5;10(6):965-74. doi: 10.2215/CJN.07970814. Epub 2015 Mar 30.
Body mass index (BMI), determined as kilograms in body weight divided by the square of the height in meters (m(2)), is inversely associated with mortality in patients undergoing maintenance hemodialysis (MHD). It is commonly inferred that differences in the weight component of the BMI equation are responsible for this negative correlation. However, there are almost no data on the relationship between height and mortality in these patients. This study was conducted to examine the association between height and mortality in MHD patients and to evaluate the contribution of height to the BMI-mortality relationship.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A prospective study conducted from July 1, 2001, through June 30, 2006, enrolled a nationally representative cohort of 117,644 MHD patients receiving treatment in DaVita, Inc. outpatient dialysis facilities with (1) known height and weight, (2) age ≥18 years, (3) dialysis vintage ≥90 days, and (4) nonoutlying BMI values (≥12 to ≤60 kg/m(2)). The end date of follow-up was June 30, 2007, and median follow-up was 852 days (interquartile range, 504-1367 days). Mortality hazard ratios were computed within sex-standardized deciles of height and weight, and outcomes included all-cause mortality and cardiovascular, gastrointestinal, cancer, and infection mortality. Hazard models were unadjusted, adjusted for case-mix variables, or adjusted for case-mix variables plus laboratory variables.
Mean age was 61±15 years; 45% of patients were women and 57% had diabetes. In adjusted models, height, also adjusted for weight, was directly associated with all-cause mortality and cardiovascular, infection, and cancer mortality. Compared with the median height decile, mortality risk in the highest height decile was 1.18 (95% confidence interval, 1.14 to 1.23) in fully adjusted analyses (P<0.001). Receiver-operating characteristic curves indicated that in adjusted analyses the contribution of height to the relationship between BMI and mortality was almost identical to that of weight.
In MHD patients, height is positively associated with mortality risk and contributes similarly to weight with regard to the negative BMI-mortality relationship.
体重指数（BMI）定义为体重（千克）除以身高（米）的平方（m²），与维持性血液透析（MHD）患者的死亡率呈负相关。通常认为，BMI公式中体重部分的差异是造成这种负相关的原因。然而，关于这些患者身高与死亡率之间关系的数据几乎没有。本研究旨在探讨MHD患者身高与死亡率之间的关联，并评估身高对BMI与死亡率关系的影响。
设计、地点、参与者及测量方法：一项前瞻性研究，从2001年7月1日至2006年6月30日，纳入了DaVita公司门诊透析设施中接受治疗的117644名具有全国代表性的MHD患者队列，这些患者需满足以下条件：（1）已知身高和体重；（2）年龄≥18岁；（3）透析龄≥90天；（4）BMI值非极端（≥12至≤60 kg/m²）。随访截止日期为2007年6月30日，中位随访时间为852天（四分位间距，504 - 1367天）。在按性别标准化的身高和体重十分位数内计算死亡风险比，结局包括全因死亡率以及心血管、胃肠道、癌症和感染死亡率。风险模型未进行调整、针对病例组合变量进行调整或针对病例组合变量加实验室变量进行调整。
平均年龄为61±15岁；45%的患者为女性，57%患有糖尿病。在调整模型中，在对体重进行调整后，身高与全因死亡率以及心血管、感染和癌症死亡率直接相关。在完全调整分析中，与身高中位数十分位数相比，最高身高十分位数的死亡风险为1.18（95%置信区间，1.14至1.23）（P<0.001）。受试者工作特征曲线表明，在调整分析中，身高对BMI与死亡率关系的影响与体重几乎相同。
在MHD患者中，身高与死亡风险呈正相关，并且在BMI与死亡率的负相关关系方面，身高与体重的影响相似。
