血液透析患者的低身体细胞质量指数：与临床参数及生存情况的关联

Low body cell mass index in hemodialysis patients: Association with clinical parameters and survival.

作者信息

Oliveira Telma, Garagarza Cristina, Valente Ana, Caetano Cristina

机构信息

Nutrition, Fresenius Medical Care, Lisbon, Portugal.

出版信息

Hemodial Int. 2020 Apr;24(2):228-236. doi: 10.1111/hdi.12822. Epub 2020 Feb 13.

DOI:10.1111/hdi.12822

PMID:32056356

Abstract

INTRODUCTION

Body cell mass (BCM) is a useful nutritional marker and is not affected by changes in the hydration status that commonly occur in hemodialysis (HD) patients. This study aimed to examine the association between body cell mass index (BCMI) and nutritional parameters, as well as its relationship with long-term survival in these patients.

METHODS

This longitudinal prospective multicenter study followed a cohort of patients in HD for 24 months. The clinical parameters of 2527 patients (mean age 70.3 ± 14.6 years, 55.8% male and mean HD vintage 58 (IQR:33-95) months) were measured and their body composition parameters were assessed by a body composition monitor before the HD session. BCM was converted to BCMI (BCM/height ) and, taking into account the mean value (6.4 ± 2.1 kg/m ), we split our study population into 2 groups: G1 (BCMI <6.4 kg/m ; n = 1366) and G2 (BCMI ≥ 6.4 kg/m ; n = 1161). All statistical tests were performed using SPSS 20.0 software. A P value lower than 0.05 was considered statistically significant.

FINDINGS

Patients with a BCMI <6.4 kg/m displayed higher age (P < 0.001), dialysis adequacy (Kt/V) (P < 0.001), total cholesterol (TC) (P = 0.033), high-density lipoprotein cholesterol (HDL-C) (P < 0.001), relative overhydration (overhydration/extracellular water [OH/ECW]) (P < 0.001), CRP (P < 0.001), fat tissue index (FTI) (P < 0.001) and lower normalized protein equivalent of nitrogen appearance (nPNA) (P < 0.001), albumin (P < 0.001), serum creatinine (P < 0.001), creatinine index (P < 0.001), potassium (P < 0.001), phosphorus (P < 0.001), calcium/phosphorus product (Ca X P) (P < 0.001), lean tissue index (LTI) (P < 0.001) and body mass index (BMI) (P = 0.046). The Kaplan-Meier survival curve showed a significantly better survival in female and male patients with BCMI ≥6.4 kg/m (P = 0.001 and P < 0.001, respectively). In the cox regression analysis, a significantly higher mortality risk was observed in G1 patients (P = 0.001).

DISCUSSION

Our study showed that a low BCMI was a mortality predictor and was associated with worse nutritional parameters in patients undergoing HD.

摘要

引言

身体细胞质量（BCM）是一个有用的营养指标，不受血液透析（HD）患者常见的水合状态变化的影响。本研究旨在探讨身体细胞质量指数（BCMI）与营养参数之间的关联，以及其与这些患者长期生存的关系。

方法

这项纵向前瞻性多中心研究对一组HD患者进行了24个月的随访。测量了2527例患者（平均年龄70.3±14.6岁，男性占55.8%，平均HD病程58（四分位间距：33 - 95）个月）的临床参数，并在HD治疗前通过身体成分监测仪评估了他们的身体成分参数。将BCM转换为BCMI（BCM/身高²），并考虑到平均值（6.4±2.1kg/m²），我们将研究人群分为两组：G1组（BCMI <6.4kg/m²；n = 1366）和G2组（BCMI≥6.4kg/m²；n = 1161）。所有统计检验均使用SPSS 20.0软件进行。P值低于0.05被认为具有统计学意义。