The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

被引:259
作者
Kalantar-Zadeh, Kamyar [1 ,2 ,3 ,4 ]
Streja, Elani [1 ,4 ]
Kovesdy, Csaba P. [5 ]
Oreopoulos, Antigone [7 ]
Noori, Nazanin [1 ]
Jing, Jennie [1 ]
Nissenson, Allen R. [3 ,6 ]
Krishnan, Mahesh [6 ]
Kopple, Joel D. [2 ,3 ,4 ]
Mehrotra, Rajnish [2 ,3 ]
Anker, Stefan D. [8 ,9 ]
机构
[1] Harbor UCLA Med Ctr, Los Angeles Biomed Res Inst, Harold Simmons Ctr Chron Dis Res & Epidemiol, Torrance, CA 90509 USA
[2] Harbor UCLA Med Ctr, Los Angeles Biomed Res Inst, Div Nephrol & Hypertens, Torrance, CA 90509 USA
[3] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA
[4] Univ Calif Los Angeles, Sch Publ Hlth, Dept Family Hlth & Epidemiol, Los Angeles, CA 90095 USA
[5] Salem Vet Affairs Med Ctr, Salem, VA USA
[6] DaVita, El Segundo, CA USA
[7] Univ Alberta, Edmonton, AB, Canada
[8] Charite Univ Sch Med, Berlin, Germany
[9] IRCCS San Raffaele, Ctr Clin & Basic Res, Rome, Italy
基金
美国国家卫生研究院;
关键词
GLOMERULAR-FILTRATION-RATE; CLINICAL-OUTCOMES; CARDIOVASCULAR-DISEASE; HEART-FAILURE; RISK-FACTOR; ALL-CAUSE; SURVIVAL; WEIGHT; INDEX; CREATININE;
D O I
10.4065/mcp.2010.0336
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To determine whether dry weight gain accompanied by an increase In muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD) PATIENTS AND METHODS in a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post HD dry weight) and 3 month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk RESULTS in the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and Independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level These associations appeared consistent across different demographic groups of patients receiving HD CONCLUSION in patients receiving long term HD, larger body size with more muscle mass appears associated with a higher survival rate A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle Controlled trials of muscle-gaining interventions in patients receiving HD are warranted
引用
收藏
页码:991 / 1001
页数:11
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