Rabbani Rizwan, Noel Edva, Boyle Suzanne, Khan Waqas Ahmad, Pronovost Paul, Gillespie Avrum
Nephrology, Temple University Hospital, Philadelphia, USA.
Cureus. 2022 Jun 13;14(6):e25892. doi: 10.7759/cureus.25892. eCollection 2022 Jun.
The principal objective of this systematic review is to determine the prognosis of end-stage renal disease (ESRD) patients on maintenance hemodialysis with high body mass index (BMI) and study the potential mechanisms behind it. PubMed and Google Scholar electronic databases covering the period of the last 30 years 1992 to 2022 are searched thoroughly and a total of 11 articles were finally selected for the study. Reference lists of included papers are also searched. Each paper was examined by two independent evaluators who also extracted data from full papers. The quality of the selected studies was assessed by different quality assessment tools and only moderate- to high-quality papers are included. In this systematic review, we studied different mechanisms explaining the obesity paradox in patients on maintenance hemodialysis, i.e., hemodynamic stability, the concentration of TNF-α receptors, neurohumoral response, role of inflammation, blood pressure, etc. also, the effect of age, gender, duration of treatment, acetyl-ghrelin on obesity paradox have been considered in our paper. This systematic review demonstrates the evidence of an inverse relationship between BMI and all-cause mortality in ESRD patients on maintenance hemodialysis.
本系统评价的主要目的是确定维持性血液透析的终末期肾病（ESRD）患者中高体重指数（BMI）的预后，并研究其背后的潜在机制。我们全面检索了1992年至2022年这30年期间的PubMed和谷歌学术电子数据库，最终共筛选出11篇文章用于本研究。我们还检索了纳入论文的参考文献列表。每篇论文由两名独立评估人员进行审查，他们也从全文中提取数据。通过不同的质量评估工具对所选研究的质量进行评估，仅纳入中高质量的论文。在本系统评价中，我们研究了解释维持性血液透析患者肥胖悖论的不同机制，即血流动力学稳定性、TNF-α受体浓度、神经体液反应、炎症作用、血压等。此外，我们的论文还考虑了年龄、性别、治疗持续时间、乙酰化胃饥饿素对肥胖悖论的影响。本系统评价证明了在维持性血液透析的ESRD患者中，BMI与全因死亡率之间存在负相关的证据。
