Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand.
Int Urol Nephrol. 2022 Feb;54(2):437-446. doi: 10.1007/s11255-021-02923-6. Epub 2021 Jun 28.
Progressive decline in lean mass and gain of fat mass are common in patients treated with peritoneal dialysis (PD). It is unclear whether body composition or its longitudinal changes contribute to increased mortality among prevalent PD patients.
This was a retrospective cohort study. Body composition was assessed using bioelectrical impedance spectroscopy (BIS). Lean and fat tissue indices were derived from lean and fat mass indexed to height-squared, respectively. The patient's baseline BIS results were used to explore its mortality risk prediction for the entire cohort. Among patients with subsequent BIS measurements, changes of lean and fat mass over time were also examined with survival outcomes.
Among all participants (n = 555, PD vintage 38 months), higher baseline lean tissue index was associated with lower mortality after adjusting for fat tissue index and confounders (HR 0.90; 95% CI 0.84-0.97, p = 0.01). However, this association was no longer significance after the final adjustment with serum albumin level (p = 0.06). A total of 136 patients had repeated BIS data. After the interval of 10.1 months during two consecutive BIS measurements, there was a strong inverse correlation between the percentage changes of lean and fat tissue indices (r = - 0.73, p < 0.001). The longitudinal changes in lean mass, either high or low categories, were not significantly associated with all-cause mortality. In contrast, patients who were classified as having low values of fat tissue index (below median) from baseline to the next BIS measurements had a lower odds of death in the univariable (HR 0.32; 95% CI 0.12-0.84, p = 0.02) but not in the adjusted models.
Among prevalent PD patients, higher baseline lean mass was independently associated with better survival. However, the longitudinal changes in lean mass were not significantly associated with mortality. In contrast, the maintenance of low fat status over time appeared to be associated with a lower likelihood of death among PD population.
在接受腹膜透析（PD）治疗的患者中，瘦体重减少和脂肪量增加是很常见的。目前尚不清楚是身体成分还是其纵向变化导致 PD 患者的死亡率增加。
这是一项回顾性队列研究。使用生物电阻抗光谱法（BIS）评估身体成分。瘦组织和脂肪组织指数分别由瘦组织和脂肪质量除以身高的平方得出。患者的基线 BIS 结果用于探索其对整个队列的死亡风险预测。在有后续 BIS 测量的患者中，还检查了随时间推移的瘦组织和脂肪量变化与生存结果之间的关系。
在所有参与者（n=555，PD 年限 38 个月）中，调整脂肪组织指数和混杂因素后，较高的基线瘦组织指数与死亡率降低相关（HR 0.90；95%CI 0.84-0.97，p=0.01）。然而，在最终调整血清白蛋白水平后，这种相关性不再具有统计学意义（p=0.06）。共有 136 名患者有重复的 BIS 数据。在两次连续 BIS 测量期间间隔 10.1 个月后，瘦组织和脂肪组织指数的百分比变化之间存在强烈的负相关（r=-0.73，p<0.001）。无论是高还是低的瘦组织量的纵向变化与全因死亡率均无显著相关性。相反，从基线到下一次 BIS 测量时被归类为脂肪组织指数低值（低于中位数）的患者，在单变量（HR 0.32；95%CI 0.12-0.84，p=0.02）但在调整模型中没有显著的死亡风险降低。
在现患 PD 患者中，较高的基线瘦体重与生存改善独立相关。然而，瘦组织量的纵向变化与死亡率无显著相关性。相反，随着时间的推移保持低脂肪状态似乎与 PD 人群的死亡风险降低相关。
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