Quero Maria, Comas Jordi, Arcos Emma, Hueso Miguel, Sandoval Diego, Montero Nuria, Cruzado-Boix Pau, Cruzado Josep M, Rama Inés
Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Clin Kidney J. 2020 Aug 16;14(3):969-982. doi: 10.1093/ckj/sfaa055. eCollection 2021 Mar.
Some studies reveal that obesity is associated with a decrease in mortality in haemodialysis (HD) patients. However, few studies have addressed the association between body mass index (BMI) and peritoneal dialysis (PD) patients.
We performed this longitudinal, retrospective study to evaluate the impact of obesity on PD patients, using data from the Catalan Registry of Renal Patients from 2002 to 2015 ( = 1573). Obesity was defined as BMI ≥30; low weight: BMI <18.5; normal range: BMI = 18.5-24.99; and pre-obesity: BMI = 25-29.99 kg/m. Variations in BMI were calculated during follow-up. The main outcomes evaluated were the technique and patient survival.
Obesity was observed in 20% of patients starting PD. We did not find differences in sex or PD modality, with the obesity group being older (65.9% are ≥55 years versus 59% non-obese, P = 0.003) and presenting more diabetes mellitus and cardiovascular disease (CVD) (47.9% obese versus 25.1% non-obese and 41.7% versus 31.5%, respectively). We did not observe differences in haemoglobin, albumin and in obese patients. Regarding peritonitis rate, we did not find any difference between groups, presenting more peritonitis patients on continuous ambulatory peritoneal dialysis and aged ≥65 years [sub-hazard ratio (SHR) = 1.75, P = 0.000 and SHR = 1.56, P = 0.009]. In relation to technique survival, we found higher transfer to HD in the obese group of patients in the univariate analysis, which was not confirmed in the multivariate analysis (SHR = 1.12, P = 0.4), and we did not find differences in mortality rate. In relation to being transplanted, the underweight group, elderly and patients with CVD or diabetic nephropathy presented less probability to undergo kidney transplantation (SHR = 0.65, 0.24, 0.5 and 0.54, P < 0.05). Obese patients did not present differences in survival with weight changes but in normal-weight patients, a gain of 7% of the basal weight during the first year had a protective effect on death risk (hazard ratio 0.6, P = 0.034).
Obese and non-obese patients starting on PD had similar outcomes.
一些研究表明，肥胖与血液透析（HD）患者死亡率降低有关。然而，很少有研究探讨体重指数（BMI）与腹膜透析（PD）患者之间的关联。
我们进行了这项纵向回顾性研究，以评估肥胖对PD患者的影响，使用了2002年至2015年加泰罗尼亚肾病患者登记处的数据（n = 1573）。肥胖定义为BMI≥30；体重过低：BMI＜18.5；正常范围：BMI = 18.5 - 24.99；以及肥胖前期：BMI = 25 - 29.99kg/m²。在随访期间计算BMI的变化。评估的主要结局是技术生存率和患者生存率。
开始接受PD治疗的患者中，20%存在肥胖。我们未发现性别或PD治疗方式上的差异，肥胖组患者年龄更大（65.9%年龄≥55岁，非肥胖组为59%，P = 0.003），且患有更多糖尿病和心血管疾病（CVD）（肥胖组分别为47.9%和41.7%，非肥胖组分别为25.1%和31.5%）。我们未观察到肥胖患者在血红蛋白、白蛋白方面存在差异。关于腹膜炎发生率，我们未发现组间有任何差异，持续非卧床腹膜透析且年龄≥65岁的患者发生腹膜炎更多[亚风险比（SHR）= 1.75，P = 0.000；SHR = 1.56，P = 0.009]。关于技术生存率，单因素分析中我们发现肥胖组患者转为HD的比例更高，但多因素分析未证实这一点（SHR = 1.12，P = 0.4），且我们未发现死亡率存在差异。关于接受移植，体重过低组、老年患者以及患有CVD或糖尿病肾病的患者接受肾脏移植的可能性较小（SHR = 0.65、0.24、0.5和0.54，P＜0.05）。肥胖患者的生存率未因体重变化而出现差异，但在体重正常的患者中，第一年体重增加7%对死亡风险具有保护作用（风险比0.6，P = 0.034）。
开始接受PD治疗的肥胖和非肥胖患者结局相似。
