Yang Yaya, Zhang Haixia, Lan Xiaolei, Qin Xianhui, Huang Yan, Wang Jieyu, Luo Pei, Wen Zhen, Li Yumin, Kong Yaozhong, Wan Qijun, Wang Qi, Huang Sheng, Liu Yan, Liu Aiqun, Liu Fanna, Yang Shenglin, Lu Yongxin, Zhao Yanhong, Chen Junzhi, Lei Zihan, He Yanhuan, Lin Zizhen, Li Youbao, Liang Min
National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Nephrology Department, the First People's Hospital of Foshan, Foshan, China.
Clin Kidney J. 2022 Sep 15;16(1):167-175. doi: 10.1093/ckj/sfac210. eCollection 2023 Jan.
Data are limited on the relationship between waist-to-hip ratio (WHR) and mortality risk among maintenance hemodialysis (MHD) patients. Moreover, the combined association of body mass index (BMI) and WHR with mortality remains uncertain. Therefore, we aimed to explore the individual and combined association of BMI and WHR with the all-cause and cardiovascular disease (CVD) mortality.
In this multicenter prospective cohort study, we enrolled 1034 MHD patients. The primary outcome was all-cause mortality and secondary outcome was CVD mortality. Multivariable Cox proportional hazards models were used to evaluate the individual and combined association of BMI and WHR with the risk of mortality.
A nonlinear inverse relationship was found between BMI and risk of all-cause mortality ( for nonlinearity <.05). Being underweight (<18.5 kg/m) was associated with higher all-cause mortality risk (HR 1.45; 95% CI 1.08-1.94) compared with normal weight (18.5-23.9 kg/m), while being overweight (24-27.9 kg/m; HR 0.96; 95% CI 0.70-1.31) and obese (≥28 kg/m; HR 1.19; 95% CI 0.62-2.26) showed no significant differences. Of note, WHR was independently and positively associated with all-cause mortality (per standard deviation increase, HR 1.13; 95% CI 1.00-1.27). When analyzed jointly, patients with low BMI (<18.5 kg/m) and high WHR (≥0.95) had the highest risk of all-cause mortality. Similar results were obtained for CVD mortality.
In patients undergoing hemodialysis from China, low BMI and high WHR were individually and jointly associated with higher risk of mortality. Our results emphasize that BMI and WHR may jointly affect the prognosis of MHD patients.
维持性血液透析（MHD）患者中，腰臀比（WHR）与死亡风险之间的关系数据有限。此外，体重指数（BMI）和WHR与死亡率的联合关联仍不确定。因此，我们旨在探讨BMI和WHR与全因死亡率和心血管疾病（CVD）死亡率的个体及联合关联。
在这项多中心前瞻性队列研究中，我们纳入了1034例MHD患者。主要结局是全因死亡率，次要结局是CVD死亡率。采用多变量Cox比例风险模型评估BMI和WHR与死亡风险的个体及联合关联。
发现BMI与全因死亡风险之间存在非线性反比关系（非线性检验P<0.05）。与正常体重（18.5 - 23.9kg/m²）相比，体重过低（<18.5kg/m²）与更高的全因死亡风险相关（HR 1.45；95%CI 1.08 - 1.94），而超重（24 - 27.9kg/m²；HR 0.96；95%CI 0.70 - 1.31）和肥胖（≥28kg/m²；HR 1.19；95%CI 0.62 - 2.26）则无显著差异。值得注意的是，WHR与全因死亡率独立正相关（每增加一个标准差，HR 1.13；95%CI 1.00 - 1.27）。联合分析时，低BMI（<18.5kg/m²）和高WHR（≥0.95）的患者全因死亡风险最高。CVD死亡率也得到了类似结果。
在中国接受血液透析的患者中，低BMI和高WHR分别及共同与更高的死亡风险相关。我们的结果强调，BMI和WHR可能共同影响MHD患者的预后。
