Franco Marcia Regina Gianotti, Colugnati Fernando Antonio Basile, Qureshi Abdul Rashid, Divino-Filho José Carolino, Fernandes Natália Maria Da Silva
Universidade Federal de Juiz de Fora.
Renal Medicine, CLINTEC, Karolinska Institute, Stockholm, Sweden.
J Bras Nefrol. 2017 Jul-Sep;39(3):267-274. doi: 10.5935/0101-2800.20170050.
Data on impact of high body mass index (BMI) on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Objective: To evaluate impact of BMI on cohort of incident elderly PD patients over time.
Prospective multicenter cohort study (December / 2004-October/2007) with 674 patients. Socio-demographic and clinical data evaluated with patients followed until death, transfer to hemodialysis (HD), recovery of renal function, loss of follow-up or transplant. Patients were divided into incident on renal replacement therapy (RRT) for PD (PD first: 230) and transferred from hemodialysis (HD first: 444). Analysis was performed comparing these two groups using chi-square or Kruskal Wallis. Similar analysis was used to compare patients on automated peritoneal dialysis (APD) vs. continuous ambulatory peritoneal dialysis (CAPD). Data were compared between patients according to BMI by ANOVA, Kruskal Wallis or chi-square. For analysis of survival, Kaplan Meier method was used and to adjust confounding variables, Cox regression proportional hazard. Joint model for longitudinal and time-dependent data was conducted, assessing impact that a longitudinal variable displays on time of survival.
Malnourished patients (76.79 ± 7.53 years) were older (p < 0.0001) with higher percentage of death (44.6%, p = 0.001); diabetes mellitus showed high prevalence in obese patients (68%, p < 0.0001); higher blood pressure levels (p = 0.002) were present in obese and overweight patients.
Increased BMI variation over time proved to be a protective factor, with a decrease of about 1% in risk of death for every BMI unit earned.
关于高体重指数（BMI）对腹膜透析（PD）患者死亡率的影响的数据并不一致，尤其是在老年人中。目的：评估BMI对老年新发PD患者队列随时间的影响。
前瞻性多中心队列研究（2004年12月至2007年10月），共纳入674例患者。对社会人口统计学和临床数据进行评估，随访患者直至死亡、转为血液透析（HD）、肾功能恢复、失访或移植。患者分为因PD开始接受肾脏替代治疗（RRT）（首次PD：230例）和从血液透析转来的患者（首次HD：444例）。使用卡方检验或Kruskal Wallis检验对这两组进行比较分析。采用类似分析比较接受自动化腹膜透析（APD）与持续非卧床腹膜透析（CAPD）的患者。根据BMI，通过方差分析、Kruskal Wallis检验或卡方检验对患者数据进行比较。对于生存分析，采用Kaplan Meier方法，并使用Cox回归比例风险模型调整混杂变量。建立纵向和时间相关数据的联合模型，评估纵向变量对生存时间的影响。
营养不良患者（76.79±7.53岁）年龄较大（p<0.0001），死亡百分比更高（44.6%，p=0.001）；糖尿病在肥胖患者中患病率较高（68%，p<0.0001）；肥胖和超重患者血压水平较高（p=0.002）。
随着时间推移，BMI变化增加被证明是一个保护因素，每增加一个BMI单位，死亡风险降低约1%。
