Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea.
Nephrol Dial Transplant. 2017 Sep 1;32(9):1549-1558. doi: 10.1093/ndt/gfw373.
Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population.
In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality.
Patients' post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2% from baseline, whereas obese patients (body mass index ≥30 kg/m 2 ) did not reach a nadir and lost ∼3.8% of their weight by the 12th month. Compared with the reference group (-2 to 2% changes in weight), the death hazard ratios (HRs) of patients with -6 to -2% and greater than or equal to -6% weight loss during the first 5 months were 1.08 (95% confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6% and ≥6% weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively.
In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.
开始透析后最初几个月， INCIDENTAL 透析患者可能会迅速减重。然而，在该人群中，体重随时间的变化趋势及其与生存率的关系尚未得到描述。
在 2007 年 1 月 1 日至 2011 年 12 月 31 日期间开始透析且在透析治疗第一年存活的 58106 例大型当代美国患者队列中，我们观察了治疗第一年期间体重变化的趋势，然后检查了透析后体重变化与全因死亡率的关系。
患者的透析后体重迅速下降，在透析第 5 个月达到最低点，与基线相比平均下降 2%，而肥胖患者（体重指数≥30kg/m 2 ）并未达到最低点，并且在第 12 个月时体重减轻了约 3.8%。与参考组（体重变化在-2%至 2%之间）相比，前 5 个月体重下降-6%至-2%和大于或等于-6%的患者死亡风险比（HR）分别为 1.08（95%置信区间，1.02-1.14）和 1.14（1.07-1.22）。此外，第 5 至 12 个月体重增加 2%-6%和≥6%的患者死亡 HR 分别为 0.91（0.85-0.97）和 0.92（0.86-0.99）。
在存活至透析治疗第一年的患者中，观察到透析后体重下降，并在第 5 个月达到最低点。在前 12 个月内体重下降幅度越大，死亡风险越高，而体重增加与第 5 至 12 个月的生存率增加相关，但与透析治疗前 5 个月无关。
