Tantisattamo Ekamol, Imhof Celine, Jager Kitty J, Hilbrands Luuk B, Guidotti Rebecca, Islam Mahmud, Katicic Dajana, Konings Constantijn, Molenaar Femke M, Nistor Ionut, Noordzij Marlies, Rodríguez Ferrero María Luisa, Verhoeven Martine A M, de Vries Aiko P J, Kalantar-Zadeh Kamyar, Gansevoort Ron T, Vart Priya
Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA, USA.
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Clin Kidney J. 2022 Mar 21;15(7):1348-1360. doi: 10.1093/ckj/sfac083. eCollection 2022 Jul.
In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19.
Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m), divided into: <18.5 (lean), 18.5-24.9 (normal weight), 25-29.9 (overweight), 30-34.9 (obese I) and ≥35 (obese II/III), with 3-month mortality was investigated using Cox proportional-hazards regression analyses.
In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients ( = 2343) and among those living with a kidney transplant ( = 817) (P = 0.99), but differed by sex (P = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively.
In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.
在2019冠状病毒病（COVID-19）的普通人群中，肥胖与死亡风险增加相关。鉴于在肾功能替代治疗（KFRT）患者中，尤其是透析患者中通常观察到肥胖悖论，我们研究了肥胖与接受透析或肾移植的COVID-19患者死亡率之间的关联。
使用来自欧洲肾脏协会COVID-19数据库（ERACODA）的数据。纳入2020年2月1日至2021年1月31日期间被诊断为COVID-19的KFRT患者。使用Cox比例风险回归分析研究将奎特利体重指数（BMI）（kg/m）分为<18.5（消瘦）、18.5 - 24.9（正常体重）、25 - 29.9（超重）、30 - 34.9（肥胖I类）和≥35（肥胖II/III类）与3个月死亡率之间的关联。
在3160例KFRT患者中（平均年龄：65岁，男性：61%），99例消瘦，1151例正常体重（参照组），1160例超重，525例肥胖I类，225例肥胖II/III类。在3个月的随访期间，这些类别中的患者死亡率分别为28%、20%、21%、23%和27%。在完全调整模型中，3个月死亡率的风险比（HR）分别为1.65 [95%置信区间（CI）：1.10，2.47]、1（参照）、1.07（95% CI：0.89，1.28）、1.17（95% CI：0.93，1.46）和1.71（95% CI：1.27，2.30）。透析患者（n = 2343）和肾移植患者（n = 817）的结果相似（P = 0.99），但存在性别差异（P = 0.019）。在男性中，上述BMI类别与3个月死亡率关联的HR分别为2.07（95% CI：1.22，3.52）、1（参照）、0.97（95% CI：0.78，1.21）、0.99（95% CI：0.74，1.33）和1.22（95% CI：0.78，1.91），在女性中相应的HR分别为1.34（95% CI：0.70，2.57）、1（参照）、1.31（95% CI：0.94，1.85）、1.54（95% CI：1.05，2.26）和2.49（95% CI：1.62，3.84）。
在接受透析或肾移植的COVID-19的KFRT患者中，肥胖与3个月时的死亡风险增加相关。这与透析患者中普遍观察到的肥胖悖论相反。需要进一步研究来证实肥胖与死亡率关联中的性别差异。
