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首页> 外文期刊>Annals of epidemiology >Factors associated with improved short term survival in obese end stage renal disease patients.
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Factors associated with improved short term survival in obese end stage renal disease patients.

机译：与肥胖终末期肾病患者短期生存改善相关的因素。

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PURPOSE: In contrast to its role in the general population, obesity, defined as body mass index (BMI) > or = 30 kg/m(2), has been associated with improved survival in patients with end stage renal disease (ESRD). This apparent benefit has not been explained. METHODS: Using the United States Renal Data System (USRDS), we performed an historical cohort study on 151,027 patients initiated on ESRD therapy between January 1, 1995 and June 30, 1997, who never received renal transplants, and who had information sufficient to calculate BMI. We explored the association of various comorbidities present at the time of dialysis initiation (from HCFA Form 2728) with the presence of obesity by logistic regression, and the association of obesity with patient survival, including specific causes of death, by Cox regression adjusting for factors known to be associated with survival in this population. RESULTS: Obese patients had an unadjusted two-year survival of 68% compared with 58% for non obese patients. Obesity wasindependently associated with a reduced risk of mortality among chronic dialysis patients (adjusted hazard ratio (AHR) 0.75, 95% confidence interval, 0.72-0.78), after controlling for all comorbidities and risk factors. However, there were significantly adverse interactions among whites (AHR 1.22, 1.14-1.30, across all causes of death) and females (AHR 1.12, 1.04-1.20, entirely due to an increased risk of infectious death). CONCLUSIONS: Obesity in patients presenting with ESRD is associated independently with reduced all cause mortality; however, the relationship is complex and is stronger in African Americans. In addition, subgroup analysis suggests that obesity is associated with increased risk of infectious death in females.
机译：目的：与肥胖在一般人群中的作用相反，肥胖定义为体重指数（BMI）>或= 30 kg / m（2），与改善终末期肾病（ESRD）患者的生存率相关。这种明显的好处尚未得到解释。方法：使用美国肾脏数据系统（USRDS），我们对1995年1月1日至1997年6月30日期间接受ESRD治疗的151,027例患者进行了历史队列研究，这些患者从未接受过肾移植，并且其信息足以计算BMI。我们通过logistic回归探讨了透析开始时存在的各种合并症（从HCFA表2728）与肥胖的关系，以及通过Cox回归调整因素，肥胖与患者生存率（包括特定的死亡原因）的关系。已知与该人群的生存有关。结果：肥胖患者未经调整的两年生存率为68％，而非肥胖患者为58％。在控制了所有合并症和危险因素后，肥胖与慢性透析患者的死亡风险降低相关（调整后的危险比（AHR）为0.75，95％置信区间为0.72-0.78）。然而，白人（AHR 1.22，1.14-1.30，所有死亡原因）和女性（AHR 1.12，1.04-1.20，完全由于感染性死亡风险增加）之间存在明显的不利相互作用。结论：ESRD患者的肥胖与所有原因死亡率的降低是独立相关的。但是，这种关系是复杂的，并且在非洲裔美国人中更为牢固。此外，亚组分析表明，肥胖与女性感染性死亡的风险增加有关。

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