Lee Jin Hyeog, Yun Hae-Ryong, Kim Hyung Woo, Park Jung Tak, Han Seung Hyeok, Kim Yong-Lim, Kim Yon Su, Yang Chul Woo, Kim Nam-Ho, Kang Shin-Wook, Yoo Tae-Hyun
Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul 16995, Republic of Korea.
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Republic of Korea.
J Clin Med. 2024 Feb 13;13(4):1059. doi: 10.3390/jcm13041059.
The association between obesity and all-cause mortality in patients undergoing kidney failure with replacement therapy (KFRT) has shown conflicting results. This study aimed to evaluate whether metabolic abnormalities (MA) increase the risk of all-cause mortality in these patients. Between 2009 and 2015, 1141 patients undergoing KFRT were recruited from the Clinical Research Center for End-Stage Renal Disease dataset. Patients were divided into four groups according to the presence of obesity and MA. Multivariate Cox proportional hazard analysis was performed to determine the association between the phenotypes and all-cause mortality. During a mean follow-up of 4.2 years, all-cause mortality was observed in 491 (43.0%) patients. Obesity had a 24% decreased risk of all-cause mortality compared with non-obesity. In contrast, the presence of MA showed a 1.53-fold increased risk of all-cause mortality. There was a significant interaction between obesity and MA ( = 0.006). In Cox proportional hazard analyses after adjustment of confounding factors, the metabolically abnormal non-obesity (MANO) phenotype showed a 1.63-fold increased risk of all-cause mortality compared with the metabolically healthy non-obesity phenotype. In subgroup analysis, the risk of all-cause mortality was higher in the MANO phenotype; this phenotype was significantly associated with a higher all-cause mortality in patients undergoing KFRT.
在接受肾脏替代治疗（KFRT）的肾衰竭患者中，肥胖与全因死亡率之间的关联呈现出相互矛盾的结果。本研究旨在评估代谢异常（MA）是否会增加这些患者的全因死亡风险。2009年至2015年间，从终末期肾病临床研究中心数据集招募了1141例接受KFRT的患者。根据肥胖和MA的存在情况将患者分为四组。进行多变量Cox比例风险分析以确定这些表型与全因死亡率之间的关联。在平均4.2年的随访期间，491例（43.0%）患者出现全因死亡。与非肥胖患者相比，肥胖患者的全因死亡风险降低了24%。相比之下，MA的存在使全因死亡风险增加了1.53倍。肥胖与MA之间存在显著的交互作用（P = 0.006）。在调整混杂因素后的Cox比例风险分析中，代谢异常的非肥胖（MANO）表型与代谢健康的非肥胖表型相比，全因死亡风险增加了1.63倍。在亚组分析中，MANO表型的全因死亡风险更高；该表型与接受KFRT患者的全因死亡率显著相关。
