国家血液透析患者队列中的肥胖与生存率：巴西透析登记处的分析。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2023-06-01 DOI:10.1111/hdi.13099

Angélica Peçanha, Fabiana B. Nerbass, Ricardo C. Sesso, Jocemir R. Lugon

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引用次数: 0

摘要

引言：一种被称为“肥胖悖论”的现象一直被报道在几个慢性血液透析患者队列中。在这种情况下，更高的体重指数（BMI）与更好的生存率有着矛盾的联系。本研究旨在使用巴西透析注册中心评估BMI对接受慢性血液透析患者死亡率的影响。方法：这是一项回顾性全国队列研究，收集了2011年1月至2018年12月期间发生的血液透析患者的数据。老年人 80 年被排除在研究之外。研究的变量是在透析单位定期收集的临床和实验室数据。主要感兴趣的变量是BMI，以整个透析治疗的中位数表示，并根据世界卫生组织（世界卫生组织）分类分为四个范围。主要结果是4天内死亡年。Cox比例风险回归分析用于检验与死亡率的相关性。研究结果：分析样本包括来自全国五个地区73个中心的5489名患者。其中，5.9%体重不足，48.3%体重正常，31.0%超重，14.7%肥胖。在这些BMI范围内的4年生存率分别为58%、70%、75%和80%。每种BMI提取物的存活概率与正常体重范围内的存活概率显著不同（p 24.9 kg/m2仍然是死亡率的独立保护因素（HR:0.76，95%CI:0.62-0.95，p = 0.016）。讨论：在巴西，超重和肥胖是慢性血液透析人群生存的保护因素。

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Obesity and survival in a national cohort of incident hemodialysis patients: An analysis of the Brazilian Dialysis Registry

Introduction

A phenomenon called the “obesity paradox” has consistently been reported in several cohorts of patients on chronic hemodialysis. In this setting, a higher body mass index (BMI) is paradoxically associated with better survival. This study aimed to evaluate the effect of BMI on mortality in patients undergoing chronic hemodialysis using the Brazilian Dialysis Registry.

Methods

This was a retrospective national cohort study with data on incident hemodialysis patients collected between January 2011 to December 2018. Those aged <18 or > 80 years were excluded from the study. The variables studied were the clinical and laboratory data regularly collected at the dialysis units. The variable of primary interest was BMI, represented as the median of the entire dialysis treatment and stratified into four ranges according to the World Health Organization (WHO) classification. The primary outcome was death within 4 years. Cox proportional hazards regression analysis was used to test associations with mortality.

Findings

The analyzed sample consisted of 5489 patients from 73 centers in five regions of the country. Of these, 5.9% were underweight, 48.3% were of normal weight, 31.0% were overweight, and 14.7% were obese. The 4-year survival rates in these BMI ranges were 58%, 70%, 75%, and 80%, respectively. The probability of survival for each BMI extract was significantly different from that in the normal-weight range (p < 0.05). In the fully adjusted Cox proportional hazard regression model, BMI > 24.9 kg/m² remained an independent protective factor for mortality (HR: 0.76, 95% CI: 0.62–0.95, p = 0.016).

Discussion

In Brazil, being overweight and obese are protective factors for survival in the chronic hemodialysis population.

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.