长时间透析期体重增加与死亡率和残余肾功能下降的关系

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-05-19 DOI:10.1111/hdi.13094

Yoshikazu Miyasato, Ramy M. Hanna, Tsuyoshi Miyagi, Yoko Narasaki, Hiroshi Kimura, Jun Morinaga, Masashi Mukoyama, Kamyar Kalantar-Zadeh

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引用次数: 0

摘要

透析间期体重增加(IDWG)是血液透析患者长透析间隔期和死亡率之间的关键关系。IDWG对残余肾功能(RKF)变化的影响尚未得到全面评估。本研究探讨了长时间间隔(IDWGL)中IDWG与死亡率和RKF快速下降的关系。方法回顾性队列研究纳入2007 - 2011年在美国透析中心接受血液透析治疗的患者。IDWGL定义为透析间隔两天的IDWG。本研究采用Cox回归模型和logistic回归模型考察了7种类型的IDWGL(0% - 1%、1% - 2%、2% - 3%[参考文献]、3% - 4%、4% - 5%、5% - 6%和≥6%)与死亡率的关系，以及肾尿素清除率(KRU)快速下降的关系。利用限制三次样条分析研究了IDWGL与研究结果之间的连续关系。研究结果:分别在35225例和6425例患者中评估了死亡率和RKF的快速下降。较高的IDWGL分类与不良后果的风险增加有关。3% ~ 4%、4% ~ 5%、5% ~ 6%和≥6% IDWGL全因死亡率的多因素校正危险比(95%置信区间)分别为1.09(1.02 ~ 1.16)、1.14(1.06 ~ 1.22)、1.16(1.06 ~ 1.28)和1.25(1.13 ~ 1.37)。3% ~ 4%、4% ~ 5%、5% ~ 6%和≥6% IDWGL患者KRU快速下降的多因素校正比值比(95%置信区间)分别为1.03(0.90 ~ 1.19)、1.29(1.08 ~ 1.55)、1.17(0.92 ~ 1.49)和1.48(1.13 ~ 1.95)。当IDWGL超过2%时，死亡率风险比和KRU快速下降的优势比持续增加。较高的IDWGL与较高的死亡风险和快速的KRU下降逐渐相关。IDWGL水平超过2%与不良后果的高风险相关。因此，IDWGL可作为死亡率和RKF下降的风险参数。

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Associations of interdialytic weight gain in the long intervals with mortality and residual kidney function decline

Introduction

Interdialytic weight gain (IDWG) is crucial in the association between long interdialytic intervals and mortality in hemodialysis patients. The impact of IDWG on changes in residual kidney function (RKF) has not been evaluated thoroughly. This study examined the associations of IDWG in the long intervals (IDWGL) with mortality and rapid RKF decline.

Methods

This retrospective cohort study included patients who initiated hemodialysis in the United States dialysis centers from 2007 to 2011. IDWGL was defined as IDWG in the two-day break between dialysis sessions. This study examined the associations of seven categories of IDWGL (0% to <1%, 1% to <2%, 2% to <3% [reference], 3% to <4%, 4% to <5%, 5% to <6%, and ≥6%) with mortality using Cox regression models and rapid decline of renal urea clearance (KRU) using logistic regression models. The continuous relationships between IDWGL and study outcomes were investigated using restricted cubic spline analyses.

Findings

Mortality and rapid RKF decline were assessed in 35,225 and 6425 patients, respectively. Higher IDWGL categories were linked to increased risk of adverse outcomes. The multivariate adjusted hazard ratios (95% confidence intervals) of all-cause mortality for 3% to <4%, 4% to <5%, 5% to <6%, and ≥6% IDWGL were 1.09 (1.02–1.16), 1.14 (1.06–1.22), 1.16 (1.06–1.28), and 1.25 (1.13–1.37), respectively. The multivariate adjusted odds ratios (95% confidence intervals) of rapid decline of KRU for 3% to <4%, 4% to <5%, 5% to <6%, and ≥6% IDWGL were 1.03 (0.90–1.19), 1.29 (1.08–1.55), 1.17 (0.92–1.49), and 1.48 (1.13–1.95), respectively. When IDWGL exceeded 2%, the hazard ratios of mortality and the odds ratios of rapid KRU decline continuously increased.

Discussion

Higher IDWGL was incrementally associated with higher mortality risk and rapid KRU decline. IDWGL level over 2% was linked to higher risk of adverse outcomes. Therefore, IDWGL may be utilized as a risk parameter for mortality and RKF decline.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.