Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
Department of Rehabilitation, Sagami Circulatory Organ Clinic, Sagamihara, Kanagawa, Japan.
J Nephrol. 2023 Sep;36(7):1983-1990. doi: 10.1007/s40620-023-01678-w. Epub 2023 Jun 26.
Low values for anthropometric indicators are risk factors for adverse clinical outcomes among patients on hemodialysis. Nonetheless, little is known about the association between the trajectory of anthropometric indicators and prognosis. We examined the association between a one-year change in anthropometric indicators and hospitalization and mortality in patients undergoing hemodialysis.
This retrospective cohort study collected data on five anthropometric indicators from patients undergoing maintenance hemodialysis: body mass index, mid-upper arm circumference, triceps skinfold, mid-arm muscle circumference, and calf circumference. We calculated their trajectories over one year. The outcomes were all-cause death and the number of all-cause hospitalizations. Negative binomial regressions were used to examine these associations.
We included 283 patients (mean age, 67.3 years; 60.4% males). During the follow-up period (median, 2.7 years), 30 deaths and 200 hospitalizations occurred. Body mass index (incident rate ratio [IRR]: 0.87; 95% confidence interval [CI] 0.85-0.90), mid-upper arm circumference (IRR: 0.94; 95% CI 0.88-0.99), triceps skinfold (IRR: 0.92; 95% CI 0.84-0.99), and mid-arm muscle circumference (IRR: 0.99; 95% CI 0.98-0.99) increases over one year were associated with a lower risk of all-cause hospitalizations and death regardless of their value at any one point in time. However, the calf circumference trajectory was not associated with clinical events (IRR: 0.94; 95% CI 0.83-1.07).
Body mass index, mid-upper arm circumference, triceps skinfold, and mid-arm muscle circumference trajectories were independently associated with clinical events. Routinely assessing these simple measures in clinical practice may provide additional prognostic information for managing patients undergoing hemodialysis.
人体测量指标低值是血液透析患者不良临床结局的危险因素。然而，人们对人体测量指标变化轨迹与预后之间的关系知之甚少。本研究旨在探讨血液透析患者一年人体测量指标变化与住院和死亡之间的关系。
本回顾性队列研究收集了 283 名接受维持性血液透析患者的 5 个人体测量指标数据：体重指数、上臂中部周径、三头肌皮褶厚度、上臂中部肌肉周径和小腿周径。我们计算了它们在一年内的变化轨迹。结局为全因死亡和全因住院次数。采用负二项回归检验这些关联。
共纳入 283 名患者（平均年龄 67.3 岁，60.4%为男性）。随访期间（中位数 2.7 年），发生 30 例死亡和 200 例住院事件。体重指数（发病率比 [IRR]：0.87；95%置信区间 [CI]：0.85-0.90）、上臂中部周径（IRR：0.94；95%CI：0.88-0.99）、三头肌皮褶厚度（IRR：0.92；95%CI：0.84-0.99）和上臂中部肌肉周径（IRR：0.99；95%CI：0.98-0.99）的增加与全因住院和死亡的风险降低相关，而与任何一点的数值无关。然而，小腿周径的变化轨迹与临床事件无关（IRR：0.94；95%CI：0.83-1.07）。
体重指数、上臂中部周径、三头肌皮褶厚度和上臂中部肌肉周径的变化轨迹与临床事件独立相关。在临床实践中定期评估这些简单的指标可能为管理血液透析患者提供额外的预后信息。
