Singer Richard, Huang Hsin-Chia
Canberra Health Services Renal Unit Garran Australian Capital Territory Australia.
School of Medicine Australian National University Acton Australian Capital Territory Australia.
Obes Sci Pract. 2023 Nov 22;10(1):e723. doi: 10.1002/osp4.723. eCollection 2024 Feb.
Excess body weight is a risk factor for the progression of chronic kidney disease (CKD), but weight loss in CKD has been associated with higher mortality. Consequently, blanket weight loss recommendations in this population are controversial. Little data is available on the patterns of weight-change in CKD. The authors aimed to describe weight-changes in moderate/severe CKD and explore associations with mortality and renal endpoints in patients with overweight and obesity.
Non-dialysis Canberra Hospital patients with estimated glomerular filtration (eGFR) < 60 mL/min/1.73 m and body mass index (BMI) ≥25 kg/m were followed for up to 5.5 years. Weight-change ≥5% was considered clinically significant. The renal endpoint was defined as the commencement of dialysis or transplant or a ≥40% fall in eGFR. Relationships between weight-change in the first year of follow-up and mortality or the renal endpoint were assessed using Cox-regression.
Three hundred ten patients (median age 75, median BMI 31 kg/m) were identified. 68% had Stage-4 CKD at baseline. Over 4.4-years median follow-up, 128 died and 140 had significant weight-change. During the first year of follow-up, 42 patients lost and 23 gained ≥5% body weight, of whom only 3 had intentionally lost weight. On multivariate regression, significant weight loss/gain at 1-year was associated with 2.74 ( < 0.0005) and 2.67 ( = 0.003) hazard of subsequent death and with 2.51 ( = 0.004) and 2.20 ( = 0.05) hazard of the renal endpoint respectively. There was no association between baseline eGFR and subsequent weight change.
Patients with moderate/severe CKD experience significant weight-change, but this has no relationship to baseline kidney function. Significant weight-change is associated with higher subsequent mortality and loss of kidney function, but this association is likely significantly affected by confounding.
超重是慢性肾脏病（CKD）进展的一个危险因素，但CKD患者体重减轻与较高的死亡率相关。因此，针对该人群的全面减重建议存在争议。关于CKD患者体重变化模式的数据很少。作者旨在描述中度/重度CKD患者的体重变化，并探讨超重和肥胖患者体重变化与死亡率及肾脏终点事件之间的关联。
对堪培拉医院未接受透析治疗、估计肾小球滤过率（eGFR）<60 mL/min/㎡且体重指数（BMI）≥25 kg/㎡的患者进行了长达5.5年的随访。体重变化≥5%被认为具有临床意义。肾脏终点事件定义为开始透析或移植，或eGFR下降≥40%。使用Cox回归评估随访第一年体重变化与死亡率或肾脏终点事件之间的关系。
共纳入310例患者（中位年龄75岁，中位BMI 31 kg/㎡）。68%的患者基线时为4期CKD。在中位随访4.4年期间，128例患者死亡，140例患者有显著的体重变化。在随访的第一年，42例患者体重减轻，23例患者体重增加≥5%，其中只有3例是有意减重。多因素回归分析显示，随访1年时显著的体重减轻/增加分别与后续死亡风险增加2.74倍（P<0.0005）和2.67倍（P=0.003）以及肾脏终点事件风险增加2.51倍（P=0.004）和2.20倍（P=0.05）相关。基线eGFR与后续体重变化之间无关联。
中度/重度CKD患者会出现显著的体重变化，但这与基线肾功能无关。显著的体重变化与更高的后续死亡率和肾功能丧失相关，但这种关联可能受到混杂因素的显著影响。
