| Autor: |
Johnson, David W., Herzig, Karen A., Purdie, David M., Chang, Wendy, Brown, Allison M., Rigby, Russell J., Campbell, Scott B., Nicol, David L., Hawley, Carmel M. |
| Zdroj: |
Peritoneal Dialysis International; November 2000, Vol. 20 Issue: 6 p715-721, 7p |
| Abstrakt: |
Objective To determine the influence of an elevated body mass index (BMI) on cardiovascular outcomes and survival in peritoneal dialysis (PD) patients.Design Prospective, observational study of a prevalent PD cohort at a single center.Setting Tertiary care institutional dialysis center.Patients The study included all patients with a BMI of at least 20 who had been receiving PD for at least 1 month as of 31 January 1996 (n= 43). Patients were classified as overweight [BMI > 27.5; mean ± standard error of mean (SEM): 32.1 ± 1.1; n= 14] or normal weight (BMI 20 – 27.5; mean ± SEM: 23.8 ± 0.4; n= 29).Outcome Measures Patient survival and adverse cardiovascular events (myocardial infarction, congestive cardiac failure, cerebrovascular accident, and symptomatic peripheral vascular disease) were recorded over a 3-year period.Results At baseline, no significant differences were seen between the groups in clinical, biochemical, nutritional, or echocardiographic parameters, except for a lower dietary protein intake (0.97 ± 0.10 g/kg/day vs 1.44 ± 0.10 g/ kg/day, p= 0.004) and a higher proportion of well-nourished patients by subjective global assessment (100% vs 72%, p< 0.05) in the overweight group. After 3 years of follow-up, 29% of overweight patients and 69% of normal-weight patients had died (p< 0.05). Using a Cox proportional hazards model, a BMI greater than 27.5 was shown to be an independent positive predictor of patient survival, with an adjusted hazard ratio (HR) of 0.09 [95% confidence interval (CI): 0.01 – 0.85; p< 0.05]. However, being overweight did not significantly influence myocardial infarction-free survival (adjusted HR: 0.33; 95% CI: 0.07 – 1.48; p= 0.15) or combined adverse cardiovascular event-free survival (adjusted HR: 0.67; 95% CI: 0.23 – 1.93; p= 0.46).Conclusions Obesity conferred a significant survival advantage in our PD population. Obese patients should therefore not be discouraged from receiving PD purely on the basis of BMI. Moreover, maintaining a higher-than-average BMI to preserve “nutritional reserve” may help to reduce the mortality and morbidity rates associated with PD. |
| Databáze: |
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