Dialysis Department of Nephrology Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.
Clin Nutr. 2022 Jul;41(7):1475-1482. doi: 10.1016/j.clnu.2022.05.012. Epub 2022 May 18.
While prior work has examined activities of daily living (ADL) dependence and malnutrition separately, the additive effects of these conditions remain uncertain. Therefore, the purpose of this study was to evaluate the joint association of malnutrition and ADL dependence with poor health outcomes in incident dialysis patients.
1457 patients from the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis database were identified for inclusion in this longitudinal study. The geriatric nutritional risk index and Barthel index were used as the evaluation tool for nutritional status and functional ability. Combined classifications of malnutrition and ADL dependence were generated with four subgroups derived. Associations between these exposures and health outcomes, including all-cause mortality, major adverse cardiovascular events (MACE), and infection-related death were investigated using Cox-proportional hazard models and competing risk survival models, respectively.
39.5% of the participants were not malnourished nor ADL dependent (normal), 30.3% were malnourished, 10.5% ADL dependent and 19.8% as having both malnutrition and ADL dependence. During 4752 person-years of follow-up, 367 (25.2%) died and 650 (44.6%) patients suffered a MACE. Compared with the reference group (ADL dependency and no-malnutrition), the combination malnourished/ADL dependent showed the strongest association with all cause death (fully-adjusted HR 2.64, 95% CI 1.79-3.89), mortality from infection (fully-adjusted HR 4.41, 95% CI 1.88-10.40), and MACE incidence (fully-adjusted HR 1.81, 95% CI 1.36-2.42). This relationship remained credible and robust in several subgroup and sensitivity analyses. Additionally, we identified this associations were higher in patients aged 75 and older.
The concurrent presence of malnutrition and ADL dependence at the time of dialysis initiation has significant detrimental impacts.
尽管先前的研究已经分别检查了日常生活活动（ADL）依赖和营养不良，但这些情况的附加影响仍不确定。因此，本研究的目的是评估营养不良和 ADL 依赖与新开始透析患者不良健康结局的联合关联。
从爱知县透析患者预后队列研究数据库中确定了 1457 名患者纳入本纵向研究。使用老年营养风险指数和巴氏量表作为评估营养状况和功能能力的工具。根据四个亚组生成营养不良和 ADL 依赖的联合分类。使用 Cox 比例风险模型和竞争风险生存模型分别研究这些暴露与全因死亡率、主要不良心血管事件（MACE）和感染相关死亡之间的关联。
39.5%的参与者既不营养不良也不依赖 ADL（正常），30.3%营养不良，10.5%依赖 ADL，19.8%同时存在营养不良和 ADL 依赖。在 4752 人年的随访期间，367 人（25.2%）死亡，650 人（44.6%）发生 MACE。与参考组（ADL 依赖和无营养不良）相比，同时存在营养不良/ADL 依赖与全因死亡（完全调整后的 HR 2.64，95%CI 1.79-3.89）、感染相关死亡（完全调整后的 HR 4.41，95%CI 1.88-10.40）和 MACE 发生率（完全调整后的 HR 1.81，95%CI 1.36-2.42）的关联最强。在几个亚组和敏感性分析中，这种关系仍然是可信和稳健的。此外，我们发现这种关联在 75 岁及以上的患者中更高。
在开始透析时同时存在营养不良和 ADL 依赖会产生显著的不良影响。
