Hoogeveen Ellen K, Rothman Kenneth J, Voskamp Pauline W M, de Mutsert Renée, Halbesma Nynke, Dekker Friedo W
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
PLoS One. 2017 Sep 5;12(9):e0184007. doi: 10.1371/journal.pone.0184007. eCollection 2017.
Obesity is associated with increased mortality and accelerated decline in kidney function in the general population. Little is known about the effect of obesity in younger and older pre-dialysis patients. The aim of this study was to assess the extent to which obesity is a risk factor for death or progression to dialysis in younger and older patients on specialized pre-dialysis care.
In a multicenter Dutch cohort study, 492 incident pre-dialysis patients (>18y) were included between 2004-2011 and followed until start of dialysis, death or October 2016. We grouped patients into four categories of baseline body mass index (BMI): <20, 20-24 (reference), 25-29, and ≥30 (obesity) kg/m2 and stratified patients into two age categories (<65y or ≥65y).
The study population comprised 212 patients younger than 65 years and 280 patients 65 years and older; crude cumulative risk of dialysis and mortality at the end of follow-up were 66% and 4% for patients <65y and 64% and 14%, respectively, for patients ≥65y. Among the <65y patients, the age-sex standardized combined outcome rate was 2.3 times higher in obese than those with normal BMI, corresponding to an excess rate of 35 events/100 patient-years. After multivariable adjustment the hazard ratios (HR) (95% CI) for the combined endpoint by category of increasing BMI were, for patients <65y, 0.92 (0.41-2.09), 1 (reference), 1.76 (1.16-2.68), and 1.81 (1.17-2.81). For patients ≥65y the BMI-specific HRs were 1.73 (0.97-3.08), 1 (reference), 1.25 (0.91-1.71) and 1.30 (0.79-1.90). In the competing risk analysis, taking dialysis as the event of interest and death as a competing event, the BMI-specific multivariable adjusted subdistribution HRs (95% CI) were, for patients <65y, 0.90 (0.38-2.12), 1 (reference), 1.47 (0.96-2.24) and 1.72 (1.15-2.59). For patients ≥65y the BMI-specific SHRs (95% CI) were 1.68 (0.93-3.02), 1 (reference), 1.50 (1.05-2.14) and 1.80 (1.23-2.65).
We found that obesity in younger pre-dialysis patients and being underweight in older pre-dialysis patients are risk factors for starting dialysis and for death, compared with those with a normal BMI.
在普通人群中，肥胖与死亡率增加及肾功能加速衰退相关。关于肥胖对年轻和老年透析前患者的影响，人们了解甚少。本研究的目的是评估在接受专门透析前护理的年轻和老年患者中，肥胖成为死亡或进展至透析的风险因素的程度。
在一项荷兰多中心队列研究中，2004年至2011年间纳入了492例初诊透析前患者（年龄>18岁），并随访至开始透析、死亡或2016年10月。我们将患者按基线体重指数（BMI）分为四类：<20、20 - 24（参照组）、25 - 29以及≥30（肥胖）kg/m²，并将患者按两个年龄类别分层（<65岁或≥65岁）。
研究人群包括212例年龄小于65岁的患者和280例年龄65岁及以上的患者；随访结束时，年龄小于65岁患者的透析和死亡粗累积风险分别为66%和4%，年龄≥65岁患者分别为64%和14%。在年龄小于65岁的患者中，肥胖患者的年龄 - 性别标准化联合结局率比BMI正常者高2.3倍，相当于每100患者年额外增加35例事件。多变量调整后，对于年龄小于65岁的患者，BMI升高类别对应的联合终点风险比（HR）（95%置信区间）分别为0.92（0.41 - 2.09）、1（参照组）、1.76（1.16 - 2.68）和1.81（1.17 - 2.81）。对于年龄≥65岁的患者，特定BMI的HR分别为1.73（0.97 - 3.08）、1（参照组）、1.25（0.91 - 1.71）和1.30（0.79 - 1.90）。在竞争风险分析中，将透析视为感兴趣事件，死亡视为竞争事件，对于年龄小于65岁的患者，特定BMI的多变量调整后亚分布风险比（HR）（95%置信区间）分别为0.90（0.38 - 2.12）、1（参照组）、1.47（0.96 - 2.24）和1.72（1.15 - 2.59）。对于年龄≥65岁的患者，特定BMI的SHR（95%置信区间）分别为1.68（0.93 - 3.02）、1（参照组）、1.50（1.05 - 2.14）和1.80（1.23 -
