Zhong Qiuxia, Lin Zizhen, Yang Yaya, Huang Yan, Lan Xiaolei, Xia Chaoying, Kong Yaozhong, Wan Qijun, Li Yumin, Huang Sheng, Liu Yan, Liu Aiqun, Liu Fanna, Qin Xianhui, Li Youbao, Liang Min
National Clinical Research Center for Kidney Disease, National Key Laboratory for Prevention and Treatment of Multi-organ Injury, Guangdong Provincial Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Nephrology Department, The First People's Hospital of Foshan, Foshan, China.
Clin Kidney J. 2025 Apr 28;18(5):sfaf124. doi: 10.1093/ckj/sfaf124. eCollection 2025 May.
Current evidence on the relationship between dietary carbohydrate intake (DCI) and mortality risk among patients undergoing maintenance hemodialysis (MHD) is limited. Moreover, the joint impact of DCI and dietary energy intake (DEI) on mortality remains unclear. Therefore, we aimed to investigate both the individual and combined associations of DCI and DEI with all-cause and cardiovascular disease (CVD) mortality.
This study included 1044 MHD patients from eight outpatient dialysis centers across China. The DCI, expressed as a percentage of carbohydrate intake in total energy intake, was determined via 24-h dietary recalls over 3 days. The study outcomes included all-cause and CVD mortality. Cox proportional hazard models were utilized to evaluate both the individual and combined associations of DCI and DEI with mortality risk.
During a median follow-up of 45.6 months, 352 deaths were recorded, of which 206 (58.5%) were due to CVD. When DCIs were assessed as quartiles, patients in the fourth quartile (≥72.1%) were associated with a greater risk of all-cause mortality [hazard ratio (HR) 2.16; 95% confidence interval (CI) 1.10, 4.25] than patients in the first quartile (<61.5%), whereas patients in the second quartile (61.5%-66.7%; HR 1.27; 95% CI 0.87, 1.87) and the third quartile (66.7%-72.1%; HR 1.40; 95% CI 0.84, 2.31) were not significantly different. A similar trend was found for CVD mortality. When analyzed jointly, patients with high DCIs (≥72.1%) and low DEIs (<25 kcal/kg/day) had the highest risk of all-cause and CVD mortality.
A higher DCI was associated with a higher risk of all-cause and CVD mortality in MHD patients. Patients with high DCIs and low DEIs had a worse survival prognosis.
目前关于维持性血液透析（MHD）患者饮食碳水化合物摄入量（DCI）与死亡风险之间关系的证据有限。此外，DCI和饮食能量摄入量（DEI）对死亡率的联合影响仍不清楚。因此，我们旨在研究DCI和DEI与全因死亡率和心血管疾病（CVD）死亡率的个体及联合关联。
本研究纳入了来自中国8个门诊透析中心的1044例MHD患者。通过3天的24小时饮食回顾来确定DCI，以碳水化合物摄入量占总能量摄入量的百分比表示。研究结局包括全因死亡率和CVD死亡率。采用Cox比例风险模型评估DCI和DEI与死亡风险的个体及联合关联。
在中位随访45.6个月期间，记录了352例死亡，其中206例（58.5%）死于CVD。当将DCI评估为四分位数时，第四四分位数（≥72.1%）的患者与全因死亡率风险更高相关[风险比（HR）2.16；95%置信区间（CI）1.10，4.25]，高于第一四分位数（<61.5%）的患者，而第二四分位数（61.5%-66.7%；HR 1.27；95% CI 0.87，1.87）和第三四分位数（66.7%-72.1%；HR 1.40；95% CI 0.84，2.31）的患者无显著差异。CVD死亡率也发现了类似趋势。联合分析时，高DCI（≥72.1%）和低DEI（<25千卡/千克/天）的患者全因和CVD死亡率风险最高。
较高的DCI与MHD患者全因和CVD死亡率风险较高相关。高DCI和低DEI的患者生存预后较差。
