BACKGROUND:The dialysis practice guideline in Japan sets a limit on the allowed interdialytic weight gain (IDWG) <6%. However, the effects of relative gain of fluid volume to body weight may differ in presence of morbid conditions. Here, we examined whether or not the associations between IDWG and mortality differ by serum albumin (sAlb), a nutritional and illness marker.
DESIGN:The study type used was prospective cohort study.
SUBJECTS:Patients who participated in the Japan Dialysis Outcomes and Practice Pattern Study (phase 1-4 [1999-2011]) and received thrice-weekly hemodialysis.
METHODS:IDWG was the exposure of interest and was collected every 4 months, divided into 7 categories as follows: <2%, 2% to 3%, 3% to 4% (reference), 4% to 5%, 5% to 6%, 6% to 7%, and >7%. sAlb was treated as both an effect modifier and confounder and dichotomized into ≥3.8 g/dL and <3.8 g/dL segments, according to the protein-energy wasting criteria proposed by the International Society of Renal Nutrition and Metabolism.
MAIN OUTCOME MEASURE:The outcome in this study was all-cause mortality.
RESULTS:A total of 8,661 patients were analyzed. Time-varying Cox regression analyses revealed that, when sAlb was ≥3.8 g/dL, an IDWG >7% was associated with greater risk of mortality (adjusted hazard ratio [AHR] 2.74; 95% confidence interval [CI], 1.49-5.05). When sAlb was <3.8 g/dL, however, IDWGs <2% (AHR 1.89; 95% CI, 1.50-2.39) and 4% to 5% (AHR 0.75; 95% CI, 0.58-0.96) were associated with mortality (P for interaction = .001). Cubic spline analyses showed that the mortality increased when IDWG exceeded 6% for patients with sAlb ≥3.8 g/dL; in contrast, for patients with sAlb <3.8 g/dL, the mortality increased when IDWG was <3% and decreased when IDWG was between 4% and 6%.
LIMITATION:The main limitation was possible residual confounding.
CONCLUSIONS:The direction and magnitude of the associations between IDWG and mortality were modified by sAlb. Dialysis experts should take these results into account when revising the clinical practice guidelines.
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【Revisiting Interdialytic Weight Gain and Mortality Association With Serum Albumin Interactions: The Japanese Dialysis Outcomes and Practice Pattern Study.].
【回顾透析间体重增加和死亡率与血清白蛋白相互作用的关系：日本透析结果和实践模式研究。】
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DOI：10.1053/j.jrn.2017.05.003文章类型：杂志文章
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背景：日本的透析实践指南对允许的透析间增重（IDWG）<6％设置了限制。但是，在存在病态的情况下，体液量相对于体重的相对增加的影响可能会有所不同。在这里，我们检查了IDWG和死亡率之间的关联是否因营养和疾病标志物血清白蛋白（sAlb）而异。
设计：使用的研究类型为前瞻性队列研究。
参加日本透析结果和实践模式研究（1-4期[1999-2011]）并每周接受三次血液透析的患者。
方法：IDWG是感兴趣的暴露量，每4个月收集一次，分为7类，分别为：<2％，2％至3％，3％至4％（参考），4％至5％，5％至6％，6％至7％和> 7％。根据国际肾脏营养与代谢学会提出的蛋白质能量浪费标准，将sAlb视为效应修饰剂和混杂因素，并分为3.8 g / dL和<3.8 g / dL的区段。
主要观察指标：本研究结果为全因死亡率。
结果：共分析了8661例患者。随时间变化的Cox回归分析显示，当sAlb≥3.8 g / dL时，IDWG> 7％与更大的死亡风险相关（调整后的危险比[AHR] 2.74; 95％置信区间[CI]，1.49-5.05 ）。但是，当sAlb <3.8 g / dL时，IDWGs <2％（AHR 1.89; 95％CI，1.50-2.39）和4％至5％（AHR 0.75; 95％CI，0.58-0.96）与死亡率相关（互动的P = .001）。三次样条分析表明，当sAlb≥3.8g / dL的患者IDWG超过6％时，死亡率增加；相反，对于sAlb <3.8 g / dL的患者，当IDWG <3％时死亡率增加，而当IDWG在4％至6％之间时死亡率降低。
局限性：主要局限性是可能的残余混杂。
结论：sAlb改变了IDWG与死亡率之间的关联的方向和大小。修订临床实践指南时，透析专家应考虑这些结果。
设计：使用的研究类型为前瞻性队列研究。
参加日本透析结果和实践模式研究（1-4期[1999-2011]）并每周接受三次血液透析的患者。
方法：IDWG是感兴趣的暴露量，每4个月收集一次，分为7类，分别为：<2％，2％至3％，3％至4％（参考），4％至5％，5％至6％，6％至7％和> 7％。根据国际肾脏营养与代谢学会提出的蛋白质能量浪费标准，将sAlb视为效应修饰剂和混杂因素，并分为3.8 g / dL和<3.8 g / dL的区段。
主要观察指标：本研究结果为全因死亡率。
结果：共分析了8661例患者。随时间变化的Cox回归分析显示，当sAlb≥3.8 g / dL时，IDWG> 7％与更大的死亡风险相关（调整后的危险比[AHR] 2.74; 95％置信区间[CI]，1.49-5.05 ）。但是，当sAlb <3.8 g / dL时，IDWGs <2％（AHR 1.89; 95％CI，1.50-2.39）和4％至5％（AHR 0.75; 95％CI，0.58-0.96）与死亡率相关（互动的P = .001）。三次样条分析表明，当sAlb≥3.8g / dL的患者IDWG超过6％时，死亡率增加；相反，对于sAlb <3.8 g / dL的患者，当IDWG <3％时死亡率增加，而当IDWG在4％至6％之间时死亡率降低。
局限性：主要局限性是可能的残余混杂。
结论：sAlb改变了IDWG与死亡率之间的关联的方向和大小。修订临床实践指南时，透析专家应考虑这些结果。
