Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan.
Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan.
J Ren Nutr. 2020 Mar;30(2):154-162. doi: 10.1053/j.jrn.2019.06.002. Epub 2019 Aug 7.
Low body mass index (BMI) is a potential risk factor for mortality in patients on maintenance hemodialysis. This suggests the usefulness of BMI as a prognostic factor and implies the importance of nutritional status, inflammation, and oxidative stress, all of which affect BMI. We aimed to evaluate BMI changes over time and the mortality risk in patients undergoing a novel combination therapy consisting of an extended-hours hemodialysis protocol without dietary restrictions, which enabled sufficient nutrition.
This is a retrospective cohort study. Patients were divided into 2 groups based on BMI change (ΔBMI < 0, ΔBMI ≥ 0) between the 3rd and 12th month after transfer to the clinic. We studied the associations of BMI changes with all-cause mortality. Further subgroup analyses were performed using Cox models. We finally studied 187 patients who were receiving the combined therapy. The main outcome measure was all-cause mortality of the study group.
The median (interquartile range) follow-up time was 4.9 (3.0-8.6) years. Overall, 138 patients were in the ΔBMI ≥ 0 group. As per unadjusted and adjusted Cox models, maintained or increased BMI during this period was associated with hazard ratios of 0.45 (confidence interval 0.23-0.87, P < .05) and 0.35 (confidence interval 0.17-0.75, P < .01) for all-cause mortality, respectively. In the same group, maintained or increased BMI was found to be significantly associated with decreased mortality in female, older, and nondiabetic patients. The data indicated that diabetic status could have a modifying effect on the association between variation in BMI and mortality (P = .006).
Extended-hours hemodialysis without dietary restrictions led to a beneficial effect of maintenance or increase in BMI, especially in females, patients aged ≥65 years, and those without diabetic nephropathy, which could lead to prolonged survival.
低体重指数（BMI）是维持性血液透析患者死亡的潜在危险因素。这表明 BMI 作为预后因素的有用性，并暗示营养状况、炎症和氧化应激的重要性，所有这些都会影响 BMI。我们旨在评估接受新型组合治疗的患者 BMI 随时间的变化情况，以及这种治疗对死亡率的影响。这种治疗包括延长治疗时间但不限制饮食的血液透析方案，以确保患者获得足够的营养。
这是一项回顾性队列研究。根据患者转至诊所后第 3 至 12 个月期间 BMI 的变化（ΔBMI＜0，ΔBMI≥0）将患者分为 2 组。我们研究了 BMI 变化与全因死亡率的相关性。进一步采用 Cox 模型进行亚组分析。最终，我们研究了 187 例接受联合治疗的患者。主要观察指标是研究组的全因死亡率。
中位（四分位间距）随访时间为 4.9（3.0-8.6）年。总体而言，138 例患者处于ΔBMI≥0 组。未经调整和调整后的 Cox 模型显示，在此期间维持或增加 BMI 与全因死亡率的风险比分别为 0.45（95%置信区间 0.23-0.87，P＜0.05）和 0.35（95%置信区间 0.17-0.75，P＜0.01）相关。在同一组中，维持或增加 BMI 与女性、年龄较大和非糖尿病患者的死亡率降低显著相关。研究数据表明，糖尿病状态可能对 BMI 变化与死亡率之间的关系具有修饰作用（P=0.006）。
无饮食限制的延长时间血液透析导致 BMI 维持或增加产生有益效果，尤其是在女性、年龄≥65 岁和无糖尿病肾病的患者中，这可能导致生存时间延长。
