Department of Geriatric Endocrinology, University of Electronic Science and Technology, Sichuan Academy of Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, P.R. China.
The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, P.R. China.
Ren Fail. 2023 Dec;45(1):2226221. doi: 10.1080/0886022X.2023.2226221.
There is a paucity of research on the association between bile acids (BAs) levels and all-cause death in patients with diabetes mellitus (DM) on maintenance hemodialysis (MHD). This study aimed to investigate the clinical characteristics of patients with DM on MHD according to different BAs levels and their impact on prognosis.
A retrospective cohort of 1,081 patients on hemodialysis at Xindu People's Hospital and the First Affiliated Hospital of Chengdu Medical College were enrolled. Demographic and clinical characteristics were collected. The relationship between BAs and all-cause death risk was fitted using restricted cubic splines (RCS), and the BAs cutoff value was calculated. Patients were divided into low and high BAs groups based on the cutoff value. The primary endpoint was all-cause death and the secondary outcomes were deaths from cardiovascular events.
Finally, 387 patients with DM on MHD were included. The median BAs level of all patients was 4.0 μmol/L. The RCS-based BAs cutoff value was 3.5 μmol/L. The BAs levels correlated negatively with total cholesterol, low-density lipoprotein, and blood calcium levels. During the follow-up, 21.7% of the patients died. The multivariate Cox regression analysis demonstrated that patients with DM on MHD with higher BAs were associated independently with a decreased risk of all-cause death (HR =0.55; 95% CI, 0.35-0.81, = 0.01) compared to those with lower BAs levels.
Higher BAs levels were associated with lower lipid levels in patients with DM on MHD. BAs is an independent risk factor for all-cause death in patients with DM on MHD.
在接受维持性血液透析（MHD）的糖尿病（DM）患者中，有关胆汁酸（BAs）水平与全因死亡之间的关联的研究甚少。本研究旨在根据不同 BAs 水平调查 MHD 患者的临床特征及其对预后的影响。
本回顾性队列研究纳入了新都区人民医院和成都医学院第一附属医院的 1081 名血液透析患者。收集了人口统计学和临床特征。使用限制性立方样条（RCS）拟合 BAs 与全因死亡风险之间的关系，并计算 BAs 的截断值。根据该截断值将患者分为低 BAs 和高 BAs 组。主要终点为全因死亡，次要结局为心血管事件死亡。
最终纳入 387 例 MHD 合并 DM 的患者。所有患者的 BAs 中位数水平为 4.0μmol/L。基于 RCS 的 BAs 截断值为 3.5μmol/L。BAs 水平与总胆固醇、低密度脂蛋白和血钙水平呈负相关。在随访期间，有 21.7%的患者死亡。多变量 Cox 回归分析表明，与低 BAs 水平相比，高 BAs 水平与 MHD 合并 DM 患者全因死亡风险降低独立相关（HR=0.55；95%CI，0.35-0.81，P=0.01）。
MHD 合并 DM 患者中，BAs 水平较高与血脂水平较低相关。BAs 是 MHD 合并 DM 患者全因死亡的独立危险因素。
