{"title":"改良肌酐指数对接受血液透析治疗的个体全因死亡率的纵向影响。","authors":"Koray Uludag, Tamer Arikan","doi":"10.5144/0256-4947.2021.361","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The modified creatinine index (mCI), as a surrogate marker of muscle mass, has been associated with poor outcomes in patients undergoing hemodialysis. However, a single assessment may not reflect the clinical significance before an adverse clinical endpoint.</p><p><strong>Objective: </strong>Analyze mCI trajectories and their association with all-cause mortality in incident hemodialysis patients.</p><p><strong>Design: </strong>Retrospective observational cohort.</p><p><strong>Setting: </strong>Outpatient dialysis facility.</p><p><strong>Patients and methods: </strong>We followed a cohort of patients who underwent maintenance hemodialysis treatment at least three times weekly for at least three months from 19 June 2010 to 29 December 2017. Clinical and laboratory features were measured at baseline. Longitudinal changes in the mCI were modeled using a joint longitudinal and survival model adjusted for baseline covariates and body mass index trajectories.</p><p><strong>Main outcome measure: </strong>All-cause mortality.</p><p><strong>Sample size: </strong>408 with 208 males (50.7%).</p><p><strong>Results: </strong>The mean (SD) age was 62.2 (12.3) years. The mCI changes were evaluated for a median (interquartile range) follow-up of 2.16 (1.13, 3.73) years. Forty-six percent (n=188) of patients reached the endpoint. A steeper slope (per 0.1 unit increase in the decrease rate) in modified creatinine index was associated with increased risk of all-cause mortality (HR, 1.04; 95% CI, 1.02-1.07; <i>P</i>=.011). In addition, an annual 1 mg/kg/day decrease in modified creatinine index level increased the hazard of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02-1.07; <i>P</i>=.001).</p><p><strong>Limitations: </strong>Residual kidney function was not observed in the data. Setting was single center and thus results may not be generalizable to other populations.</p><p><strong>Conclusion: </strong>All-cause death was significantly associated with loss of muscle mass over time. Longitudinal trajectories of nutritional markers may predict the clinical outcomes in patients undergoing hemodialysis. This may also be valuable for individual risk stratification. Furthermore, early management may provide an opportunity to improve patient survival.</p><p><strong>Conflict of interest: </strong>None.</p>","PeriodicalId":8016,"journal":{"name":"Annals of Saudi Medicine","volume":"41 6","pages":"361-368"},"PeriodicalIF":1.5000,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/44/0256-4947.2021.361.PMC8650593.pdf","citationCount":"0","resultStr":"{\"title\":\"Longitudinal effects of modified creatinine index on all-cause mortality in individuals receiving hemodialysis treatment.\",\"authors\":\"Koray Uludag, Tamer Arikan\",\"doi\":\"10.5144/0256-4947.2021.361\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The modified creatinine index (mCI), as a surrogate marker of muscle mass, has been associated with poor outcomes in patients undergoing hemodialysis. However, a single assessment may not reflect the clinical significance before an adverse clinical endpoint.</p><p><strong>Objective: </strong>Analyze mCI trajectories and their association with all-cause mortality in incident hemodialysis patients.</p><p><strong>Design: </strong>Retrospective observational cohort.</p><p><strong>Setting: </strong>Outpatient dialysis facility.</p><p><strong>Patients and methods: </strong>We followed a cohort of patients who underwent maintenance hemodialysis treatment at least three times weekly for at least three months from 19 June 2010 to 29 December 2017. Clinical and laboratory features were measured at baseline. Longitudinal changes in the mCI were modeled using a joint longitudinal and survival model adjusted for baseline covariates and body mass index trajectories.</p><p><strong>Main outcome measure: </strong>All-cause mortality.</p><p><strong>Sample size: </strong>408 with 208 males (50.7%).</p><p><strong>Results: </strong>The mean (SD) age was 62.2 (12.3) years. The mCI changes were evaluated for a median (interquartile range) follow-up of 2.16 (1.13, 3.73) years. Forty-six percent (n=188) of patients reached the endpoint. A steeper slope (per 0.1 unit increase in the decrease rate) in modified creatinine index was associated with increased risk of all-cause mortality (HR, 1.04; 95% CI, 1.02-1.07; <i>P</i>=.011). In addition, an annual 1 mg/kg/day decrease in modified creatinine index level increased the hazard of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02-1.07; <i>P</i>=.001).</p><p><strong>Limitations: </strong>Residual kidney function was not observed in the data. Setting was single center and thus results may not be generalizable to other populations.</p><p><strong>Conclusion: </strong>All-cause death was significantly associated with loss of muscle mass over time. Longitudinal trajectories of nutritional markers may predict the clinical outcomes in patients undergoing hemodialysis. This may also be valuable for individual risk stratification. Furthermore, early management may provide an opportunity to improve patient survival.</p><p><strong>Conflict of interest: </strong>None.</p>\",\"PeriodicalId\":8016,\"journal\":{\"name\":\"Annals of Saudi Medicine\",\"volume\":\"41 6\",\"pages\":\"361-368\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2021-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/44/0256-4947.2021.361.PMC8650593.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Saudi Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5144/0256-4947.2021.361\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/12/2 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5144/0256-4947.2021.361","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/12/2 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Longitudinal effects of modified creatinine index on all-cause mortality in individuals receiving hemodialysis treatment.
Background: The modified creatinine index (mCI), as a surrogate marker of muscle mass, has been associated with poor outcomes in patients undergoing hemodialysis. However, a single assessment may not reflect the clinical significance before an adverse clinical endpoint.
Objective: Analyze mCI trajectories and their association with all-cause mortality in incident hemodialysis patients.
Design: Retrospective observational cohort.
Setting: Outpatient dialysis facility.
Patients and methods: We followed a cohort of patients who underwent maintenance hemodialysis treatment at least three times weekly for at least three months from 19 June 2010 to 29 December 2017. Clinical and laboratory features were measured at baseline. Longitudinal changes in the mCI were modeled using a joint longitudinal and survival model adjusted for baseline covariates and body mass index trajectories.
Main outcome measure: All-cause mortality.
Sample size: 408 with 208 males (50.7%).
Results: The mean (SD) age was 62.2 (12.3) years. The mCI changes were evaluated for a median (interquartile range) follow-up of 2.16 (1.13, 3.73) years. Forty-six percent (n=188) of patients reached the endpoint. A steeper slope (per 0.1 unit increase in the decrease rate) in modified creatinine index was associated with increased risk of all-cause mortality (HR, 1.04; 95% CI, 1.02-1.07; P=.011). In addition, an annual 1 mg/kg/day decrease in modified creatinine index level increased the hazard of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02-1.07; P=.001).
Limitations: Residual kidney function was not observed in the data. Setting was single center and thus results may not be generalizable to other populations.
Conclusion: All-cause death was significantly associated with loss of muscle mass over time. Longitudinal trajectories of nutritional markers may predict the clinical outcomes in patients undergoing hemodialysis. This may also be valuable for individual risk stratification. Furthermore, early management may provide an opportunity to improve patient survival.
期刊介绍：
The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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