Kim Hyoungnae, Kim Joohwan, Seo Changhwan, Lee Misol, Cha Min-Uk, Jung Su-Young, Jhee Jong Hyun, Park Seohyun, Yun Hae-Ryong, Kee Youn Kyung, Yoon Chang-Yun, Oh Hyung Jung, Park Jung Tak, Chang Tae Ik, Yoo Tae-Hyun, Kang Shin-Wook, Han Seung Hyeok
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Kidney Disease Research, Yonsei University, Seoul, Korea.
Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Kidney Res Clin Pract. 2017 Mar;36(1):39-47. doi: 10.23876/j.krcp.2017.36.1.39. Epub 2017 Mar 31.
Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition.
We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT.
Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile ( = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37-0.87; = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43-0.94; = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44-0.97; = 0.03).
This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
许多流行病学研究都报道了肥胖悖论这一存在争议的概念。急性肾损伤（AKI）的出现会加速能量消耗过程，尤其是在需要持续肾脏替代治疗（CRRT）的患者中。因此，我们旨在研究肥胖在这种高分解代谢状态下是否能带来生存益处。
我们对2010年至2014年间因各种原因的AKI而接受CRRT的212例患者进行了一项观察性研究。研究终点定义为CRRT开始后30天内发生的死亡。
根据体重指数（BMI）三分位数将患者分为三组。在CRRT开始后的≥30天内，最高三分位数组中有39例患者（57.4%）死亡，而最低三分位数组中有58例患者（78.4%）死亡（P = 0.02）。在对混杂因素进行校正的多变量分析中，BMI最高三分位数与死亡风险降低显著相关（风险比[HR]，0.57；95%置信区间[CI]，0.37 - 0.87；P = 0.01）。这种显著关联在60天（HR，0.64；95% CI，0.43 - 0.94；P = 0.03）和90天死亡率（HR，0.66；95% CI，0.44 - 0.97；P = 0.03）时保持不变。
本研究表明，在接受CRRT的AKI患者中，较高的BMI比较低的BMI具有生存益处。
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