Ishida Yuria, Maeda Keisuke, Murotani Kenta, Shimizu Akio, Ueshima Junko, Nagano Ayano, Sonoi Norihiro, Inoue Tatsuro, Mori Naoharu
Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.
Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Nutritional Therapy Support Center, Aichi Medical University Hospital, Nagakute, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.
Nutrition. 2023 Dec;116:112147. doi: 10.1016/j.nut.2023.112147. Epub 2023 Jul 1.
This study aimed to investigate body mass index (BMI) and rate of weight change associated with adverse outcomes in Asian patients with chronic kidney disease.
A retrospective cohort study was performed between April 2014 and June 2022 using the administrative claims database compiled by the Japan Medical Data Center. Patients were defined as individuals with comorbidities with chronic kidney disease stages 3 to 5 on admission and were aged ≥40 y with BMI at admission and BMI information from a previous admission 3 to 12 mo earlier. Restricted cubic spline analysis and thin-plate smoothed spline analysis were performed.
A total of 10 802 individuals were analyzed. The mean age was 74.6 ± 11.3 y, number of men was 7175 (66.4%), and 2115 (19.6%) deaths were recorded. Smoothed splines for BMI found that low BMI was associated with high hazard ratio (HR) (BMI = 18.5 kg/m; HR = 1.3 [1.2-1.4]). Smoothed splines of weight change found higher HR with increasing rate of weight change for both weight gain and loss (weight change rate = -10%; HR = 1.4 [1.3-1.5]; weight change rate = 10%; HR = 1.2 [1.1-1.3]). In thin-plate smoothed spline analysis, the U-curve had a higher odds ratio as BMI decreased in patients with or without dialysis and as the degree of weight change increased.
We found trends in BMI and rate of weight change associated with mortality in Asian patients with chronic kidney disease.
本研究旨在调查亚洲慢性肾脏病患者的体重指数（BMI）及体重变化率与不良结局之间的关联。
2014年4月至2022年6月期间，利用日本医疗数据中心汇编的行政索赔数据库进行了一项回顾性队列研究。患者定义为入院时患有3至5期慢性肾脏病合并症、年龄≥40岁且有入院时BMI及3至12个月前上次入院时BMI信息的个体。进行了受限立方样条分析和薄板平滑样条分析。
共分析了10802名个体。平均年龄为74.6±11.3岁，男性7175名（66.4%），记录到2115例（19.6%）死亡。BMI的平滑样条显示低BMI与高风险比（HR）相关（BMI = 18.5 kg/m²；HR = 1.3 [1.2 - 1.4]）。体重变化的平滑样条显示，体重增加和体重减轻时，随着体重变化率增加，HR均升高（体重变化率 = -10%；HR = 1.4 [1.3 - 1.5]；体重变化率 = 10%；HR = 1.2 [1.1 - 1.3]）。在薄板平滑样条分析中，无论是否接受透析，随着BMI降低以及体重变化程度增加，U曲线的比值比更高。
我们发现亚洲慢性肾脏病患者的BMI及体重变化率与死亡率之间存在相关趋势。
