Influence of Body Mass Index on the Association of Weight Changes with Mortality in Hemodialysis Patients

被引：49

作者：

Cabezas-Rodriguez, Ivan ^{[1
]}

Carrero, Juan Jesus ^{[2
,3
]}

Zoccali, Carmine ^{[4
]}

Qureshi, Abdul Rashid ^{[2
,3
]}

Ketteler, Markus ^{[5
]}

Floege, Juergen ^{[6
]}

London, Gerard ^{[7
]}

Locatelli, Francesco ^{[8
]}

Gorriz, Jose Luis ^{[9
]}

Rutkowski, Boleslaw ^{[10
]}

Memmos, Dimitrios ^{[11
]}

Ferreira, Anibal ^{[12
,13
]}

Covic, Adrian ^{[14
]}

Teplan, Vladimir ^{[15
]}

Bos, Willem-Jan ^{[16
]}

Kramar, Reinhard ^{[17
]}

Pavlovic, Drasko ^{[18
]}

Goldsmith, David ^{[19
]}

Nagy, Judit ^{[20
,21
]}

Benedik, Miha ^{[22
]}

Verbeelen, Dierik ^{[23
]}

Tielemans, Christian ^{[24
]}

Wuethrich, Rudolf P. ^{[25
]}

Martin, Pierre-Yves ^{[26
]}

Martinez-Salgado, Carlos ^{[27
]}

Fernandez-Martin, Jose Luis ^{[1
]}

Cannata-Andia, Jorge B. ^{[1
]}

机构：

[1] Univ Oviedo, Hosp Univ Cent Asturias, Bone & Min Res Unit, Inst Reina Sofia Invest,REDinREN ISCIII, Oviedo, Asturias, Spain

[2] Karolinska Inst, Div Renal Med, Stockholm, Sweden

[3] Karolinska Inst, Baxter Novum, Dept Clin Sci Intervent & Technol, Stockholm, Sweden

[4] Osped Riuniti, CNR, Clin Epidemiol & Physiopathol Renal Dis & Hypert, Ancona, Italy

[5] Klinikum Coburg, Div Nephrol, Coburg, Germany

[6] Rhein Westfal TH Aachen, Dept Nephrol & Clin Immunol, Aachen, Germany

[7] Ctr Hosp FH Manhes, Fleury Merogis, France

[8] Alessandro Manzoni Hosp, Dept Nephrol Dialysis & Renal Transplant, Lecce, Italy

[9] Hosp Univ Dr Peset, Valencia, Spain

[10] Gdansk Medical Univ, Dept Nephrol Transplantol & Internal Med, Gdansk, Poland

[11] Hippokrateion Hosp, Univ Dept Nephrol, Thessaloniki, Greece

[12] Univ Nova Lisboa, Nephrol Dept, Hosp Curry Cabral, Lisbon, Portugal

[13] Univ Nova Lisboa, Fac Ciencias Med, Lisbon, Portugal

[14] Univ Med Gr T Popa, Iasi, Romania

[15] Inst Clin Exp Med, Prague, Czech Republic

[16] St Antonious Hosp, Dept Internal Med, Nieuwegein, Netherlands

[17] Klinikum Kreuzschwestern Wels GmbH, Interne Abt Nephrol, Wels, Austria

[18] Sestre Milosrdnice Univ Hosp, Dept Nephrol & Dialysis, Zagreb, Croatia

[19] UK Kings Hlth Partners AHSC, Guys & St Thomas NHS Fdn Hosp Kings Hlth Partner, Dept Nephrol, London, England

[20] Univ Med Sch Pecs, Dept Med 2, Pecs, Hungary

[21] Univ Med Sch Pecs, Nephrol Ctr, Pecs, Hungary

[22] Univ Med Ctr, Dept Nephrol, Ljubljana, Slovenia

[23] Free Univ Brussels, Brussels, Belgium

[24] UZ Brussel, Brussels, Belgium

[25] Univ Hosp, Div Nephrol, Zurich, Switzerland

[26] Geneva Univ Hosp, Div Nephrol, Geneva, Switzerland

[27] Hosp Univ Salamanca, IECSCYL Inst Biosanit Salamanca IBSAL, Salamanca, Spain

来源：

CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2013年 / 8卷 / 10期

基金：

瑞典研究理事会;

关键词：

CHRONIC KIDNEY-DISEASE; SURVIVAL ADVANTAGE; OBESITY PARADOX; TERM SURVIVAL; ALL-CAUSE; OUTCOMES; SIZE; INFLAMMATION; OVERWEIGHT; SURROGATES;

D O I：

10.2215/CJN.10951012

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background and ObjectivesA high body mass index (BMI) is associated with lower mortality in patients undergoing hemodialysis. Short-term weight gains and losses are also related to lower and higher mortality risk, respectively. The implications of weight gain or loss may, however, differ between obese individuals and their nonobese counterparts.Design, Setting, Participants, & MeasurementsThe Current Management of Secondary Hyperparathyroidism: A Multicenter Observational Study (COSMOS) is an observational study including 6797 European hemodialysis patients recruited between February 2005 and July 2007, with prospective data collection every 6 months for 3 years. Time-dependent Cox proportional hazard regressions assessed the effect of BMI and weight changes on mortality. Analyses were performed after patient stratification according to their starting BMI.ResultsAmong 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m(2)), 11% were underweight, 31% were overweight, and 16% were obese (BMI 30 kg/m(2)). Weight loss or gain (<1% or >1% of body weight) was strongly associated with higher rates of mortality or survival, respectively. After stratification by BMI categories, this was true in nonobese categories and especially in underweight patients. In obese patients, however, the association between weight loss and mortality was attenuated (hazard ratio, 1.28 [95% confidence interval (CI), 0.74 to 2.14]), and no survival benefit of gaining weight was seen (hazard ratio, 0.98 [95% CI, 0.59 to 1.62]).ConclusionsAssuming that these weight changes were unintentional, our study brings attention to rapid weight variations as a clinical sign of health monitoring in hemodialysis patients. In addition, a patient's BMI modifies the strength of the association between weight changes with mortality.

引用

页码：1725 / 1733

页数：9

共 41 条

[21] Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients [J].