DENVER (EGMN) – Obese dialysis patients younger than age 65 years were 1.6 times more likely to die within 7 years, compared with their younger, normal-weight dialysis counterparts.
In addition, young and elderly dialysis patients alike who were underweight faced about a twofold increased risk of dying within the same time frame.
The findings come from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective analysis of 1,749 dialysis patients at 38 centers who were at least 18 years old at their first dialysis treatment and were followed until death, transplantation, or a maximum of 7 years.
“Mortality patterns of body mass index differ between young and elderly dialysis patients,” Dr. Ellen K. Hoogeveen said during a press briefing Nov. 18 at the annual meeting of the American Society of Nephrology, where the findings were presented. “Obesity may be harmful in patients younger than 65 years. For patients younger than 65 years starting with dialysis, it is important to strive for normal weight.”
At baseline, the researchers classified patients into one of two age groups: young (younger than age 65) and elderly (age 65 and older). They also classified them into one of four weight groups based on body mass index: underweight (less than 20 kg/m2), normal weight (20-25 kg/m2), overweight (25-30 kg/m2), and obese (30 kg/m2 or higher). They used Cox regression analysis to calculate hazard ratios associated with BMI categories, and used normal weight as the reference category
Dr. Hoogeveen, of the department of nephrology at Jeroen Bosch Hospital, Den Bosch, the Netherlands, reported that the mean age of the younger patients was 51 years, while the mean age of elderly patients was 73 years. The mean BMI of both groups was 24 kg/m2, and more than half were men (62% in each group).
The 7-year mortality rate for all patients was 67%. When the researchers adjusted for age, gender, smoking, cardiovascular disease, and modality of dialysis, they found that younger patients who were obese at baseline were 1.6 times more likely to die within 7 years than were younger, normal-weight patients. Elderly obese patients were 1.1 times more likely to die within 7 years than were younger, normal-weight patients, a statistically significant difference.
In addition, young and elderly dialysis patients alike who were underweight at baseline were at significantly increased risk of dying within 7 years, compared with younger patients who had a normal BMI (hazard ratios of 2.2 and 1.6, respectively).
One of the study authors, Dr. Elisabeth Boeschoten, is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All of the other authors reported no relevant financial disclosures.
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丹佛(EGMN)——年龄≥65岁的肥胖透析患者在7年内死亡的风险较更年轻且体重正常的患者高1.6倍。体重低于正常值的透析患者在7年内的死亡风险增高大约2倍。
这项名为NECOSAD(旨在调查透析治疗恰当性的荷兰合作研究)的研究对来自38所医学中心的1,749例透析患者进行了前瞻性分析，患者首次接受透析治疗时年龄均≥18岁，随访在患者死亡，接受肾移植手术或随访时间满7年后停止。研究者依照患者基线时的年龄和体重指数(BMI)值对其进行了如下分组：年轻(年龄＜65岁)与年老(年龄≥65岁)患者，平均年龄分别为51和73岁，BMI均值均为24 kg/m2且男性所占比例均超过一半(62%)；体重过轻(BMI＜20 kg/m2)，体重正常(BMI介于 20~25 kg/m2)，超重(BMI介于 25~30 kg/m2)和肥胖(BMI≥30 kg/m2)患者。研究使用Cox回归模型对与BMI分类相关的危险比进行了计算(以正常体重组为参考类别)。
研究发现，所有患者的7年死亡率为67%。当校正了年龄、性别、吸烟、心血管疾病和透析治疗模式等因素后，研究者发现基线时肥胖的年轻患者7年内死亡风险是同样年轻但体重正常患者的1.6倍。此外，年老肥胖患者7年内的死亡风险是年轻且体重正常患者的1.1倍，差异具有统计学意义。此外，与BMI正常的年轻患者相比，基线时体重过低的患者7年内死亡风险显著增高(危险比分别为2.2和1.6)。
研究表明，透析患者的死亡风险模式随BMI的变化而变化，肥胖是年龄＜65岁透析患者的有害因素。此类患者应努力保持正常体重，否则死亡风险就会增高。
一位研究者是安进公司和百特公司的顾问，还接受了来自多家公司的研究经费。其余研究者无相关经济利益披露。
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