透析老年人群中营养状况差与死亡有关。

IF 3.3 Q2 GERIATRICS & GERONTOLOGY
D Azzolino, S Vettoretti, M M Poggi, A Soldati, L Caldiroli, L A Dalla Vecchia, M Cesari
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引用次数: 0

摘要

背景:接受血液透析的老年患者营养不良的发生率很高,而且往往与体重迅速下降直至恶病质有关:我们旨在研究接受血液透析的老年患者营养状况不良与死亡率之间的关系是否与合并症和其他风险因素无关:设计:回顾性纵向研究:地点:意大利米兰 Policlinic 医院肾脏病、透析和肾移植科:共 107 名接受血液透析至少三个月的患者:记录社会人口学、临床和生物学数据。无意体重减轻(UWL)定义为 3 个月内体重减轻 > 5%,或 6 个月内体重减轻 > 10%。我们计算了 21 项虚弱指数,其中包括该人群中与营养不良和死亡率相关的临床症状。我们采用未经调整和调整的 Cox 比例危险模型来检验 UWL、白蛋白和转铁蛋白水平与死亡之间的关系。根据卡普兰-梅耶估计值进行了生存分析:患者年龄为 79 (±7.7) 岁;38 名(35%)为女性。31名患者(29%)在随访期间死亡。18名患者(16.8%)在随访期间出现过尿失禁。在未经调整的模型中,甚至在逐步纳入潜在混杂因素后,UWL 仍与死亡呈正相关。低白蛋白水平仅在未调整模型和部分调整模型中与死亡呈正相关,而低转铁蛋白水平在所有模型中均与死亡无关。同时出现超低血糖和白蛋白水平低于 3.5 毫克/分升的患者死亡率明显更高:结论:在接受慢性血液透析的老年患者中,UWL 与死亡率相关,与合并症和其他风险因素无关。同时出现超低血糖和低白蛋白水平的患者死亡率最高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Poor Nutritional Status Is Associated with Death in a Population of Dialyzed Older Persons.

Background: Older patients in hemodialysis have high prevalence of malnutrition that is often associated with rapid weight loss till cachexia.

Objectives: We aimed to investigate whether in older patients undergoing hemodialysis the association between poor nutritional status and mortality may be independent of comorbidities and other risk factors.

Design: Retrospective longitudinal study.

Setting: Unit of Nephrology, Dialysis and Kidney Transplantation of the Policlinic Hospital of Milan, Milan, Italy.

Participants: A total of 107 prevalent patients undergoing hemodialysis for at least three months.

Measurements: Sociodemographic, clinical, and biological data were recorded. Unintentional weight loss (UWL) was defined as loss of body weight > 5% in 3 months or > 10% in 6 months. We computed a 21-item Frailty Index that included clinical conditions associated with malnutrition and mortality in this population. Unadjusted and adjusted Cox proportional hazard models were performed to test the association of UWL, albumin and transferrin levels with death. Survival analyses based on Kaplan-Meier estimates were performed.

Results: Patients' age was 79 (±7.7) years; 38 (35%) were women. Thirty-one patients (29%) died during follow-up. Eighteen (16.8%) patients experienced UWL during the follow-up period. UWL was positively associated with death in the unadjusted model and even after the progressive inclusion of potential confounders. Low albumin levels were positively associated with death only in the unadjusted and partially adjusted models while low transferrin levels were not associated with death in none of the models. Mortality was significantly higher in those patients experiencing both UWL and albumin levels below 3.5 mg/dL.

Conclusions: In older patients undergoing chronic hemodialysis UWL is associated with mortality independently of comorbidities and other risk factors. Patients presenting both UWL and low albumin levels were those experiencing the worst outcomes in terms of mortality.

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来源期刊
Journal of Frailty & Aging
Journal of Frailty & Aging GERIATRICS & GERONTOLOGY-
CiteScore
5.90
自引率
7.70%
发文量
54
期刊介绍: The Journal of Frailty & Aging is a peer-reviewed international journal aimed at presenting articles that are related to research in the area of aging and age-related (sub)clinical conditions. In particular, the journal publishes high-quality papers describing and discussing social, biological, and clinical features underlying the onset and development of frailty in older persons.          The Journal of Frailty & Aging is composed by five different sections: - Biology of frailty and aging In this section, the journal presents reports from preclinical studies and experiences focused at identifying, describing, and understanding the subclinical pathophysiological mechanisms at the basis of frailty and aging. - Physical frailty and age-related body composition modifications Studies exploring the physical and functional components of frailty are contained in this section. Moreover, since body composition plays a major role in determining physical frailty and, at the same time, represents the most evident feature of the aging process, special attention is given to studies focused on sarcopenia and obesity at older age. - Neurosciences of frailty and aging The section presents results from studies exploring the cognitive and neurological aspects of frailty and age-related conditions. In particular, papers on neurodegenerative conditions of advanced age are welcomed. - Frailty and aging in clinical practice and public health This journal’s section is devoted at presenting studies on clinical issues of frailty and age-related conditions. This multidisciplinary section particularly welcomes reports from clinicians coming from different backgrounds and specialties dealing with the heterogeneous clinical manifestations of advanced age. Moreover, this part of the journal also contains reports on frailty- and age-related social and public health issues. - Clinical trials and therapeutics This final section contains all the manuscripts presenting data on (pharmacological and non-pharmacological) interventions aimed at preventing, delaying, or treating frailty and age-related conditions.The Journal of Frailty & Aging is a quarterly publication of original papers, review articles, case reports, controversies, letters to the Editor, and book reviews. Manuscripts will be evaluated by the editorial staff and, if suitable, by expert reviewers assigned by the editors. The journal particularly welcomes papers by researchers from different backgrounds and specialities who may want to share their views and experiences on the common themes of frailty and aging.The abstracting and indexing of the Journal of Frailty & Aging is covered by MEDLINE (approval by the National Library of Medicine in February 2016).
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