{"title":"潜在的心血管-骨骼-骨骼肌轴紊乱与血液透析患者的发病率和死亡率:Q 队列研究。","authors":"Hokuto Arase, Shunsuke Yamada, Masatomo Taniguchi, Hiroaki Ooboshi, Kazuhiko Tsuruya, Takanari Kitazono, Toshiaki Nakano","doi":"10.1093/ckj/sfae154","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Disturbances in the cardiovascular system, bone and skeletal muscle are independent risk factors for death among patients receiving haemodialysis (HD). However, the combined impact of disorders of these three organs on morbidity and mortality is unclear in the HD population.</p><p><strong>Methods: </strong>A total of 3031 Japanese patients on maintenance HD were prospectively followed. The outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and bone fracture. Patients were divided into four groups (G1-G4) according to the baseline number of diseased organs represented as histories of cardiovascular disease and bone fractures and the presence of low skeletal muscle mass as follows: G1, no organ; G2, one organ; G3, two organs; G4, three organs. Multivariable-adjusted survival models were used to analyse associations between the number of diseased organs and outcomes.</p><p><strong>Results: </strong>During a 4-year follow-up, 499 deaths, 540 MACE and 140 bone fractures occurred. In the Cox proportional hazards model, the risk for all-cause mortality was significantly higher in G2, G3 and G4 than in G1 as the reference {hazard ratio: G2, 2.16 [95% confidence interval (CI) 1.65-2.84], G3, 3.10 [95% CI 2.27-4.23] and G4, 3.11 [95% CI 1.89-5.14]}. Similarly, the risks for developing MACE and bone fractures were significantly elevated as the number of organ disorders increased.</p><p><strong>Conclusions: </strong>Multiple disorders of the cardiovascular-bone-skeletal muscle axis are strong predictors of morbidity and mortality in patients undergoing HD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196899/pdf/","citationCount":"0","resultStr":"{\"title\":\"Disturbance in the potential cardiovascular-bone-skeletal muscle axis and morbidity and mortality in patients undergoing haemodialysis: the Q-Cohort Study.\",\"authors\":\"Hokuto Arase, Shunsuke Yamada, Masatomo Taniguchi, Hiroaki Ooboshi, Kazuhiko Tsuruya, Takanari Kitazono, Toshiaki Nakano\",\"doi\":\"10.1093/ckj/sfae154\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Disturbances in the cardiovascular system, bone and skeletal muscle are independent risk factors for death among patients receiving haemodialysis (HD). However, the combined impact of disorders of these three organs on morbidity and mortality is unclear in the HD population.</p><p><strong>Methods: </strong>A total of 3031 Japanese patients on maintenance HD were prospectively followed. The outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and bone fracture. Patients were divided into four groups (G1-G4) according to the baseline number of diseased organs represented as histories of cardiovascular disease and bone fractures and the presence of low skeletal muscle mass as follows: G1, no organ; G2, one organ; G3, two organs; G4, three organs. Multivariable-adjusted survival models were used to analyse associations between the number of diseased organs and outcomes.</p><p><strong>Results: </strong>During a 4-year follow-up, 499 deaths, 540 MACE and 140 bone fractures occurred. In the Cox proportional hazards model, the risk for all-cause mortality was significantly higher in G2, G3 and G4 than in G1 as the reference {hazard ratio: G2, 2.16 [95% confidence interval (CI) 1.65-2.84], G3, 3.10 [95% CI 2.27-4.23] and G4, 3.11 [95% CI 1.89-5.14]}. 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引用次数: 0
摘要
背景:心血管系统、骨骼和骨骼肌紊乱是血液透析(HD)患者死亡的独立风险因素。然而,在血液透析人群中,这三个器官的病变对发病率和死亡率的综合影响尚不清楚:方法:对 3031 名接受维持性血液透析的日本患者进行了前瞻性随访。研究结果包括全因死亡率、主要不良心血管事件(MACE)和骨折。根据以心血管疾病和骨折病史为代表的病变器官基线数量以及是否存在低骨骼肌质量,将患者分为以下四组(G1-G4):G1,无器官;G2,一个器官;G3,两个器官;G4,三个器官。采用多变量调整生存模型分析患病器官数量与结果之间的关系:结果:在为期4年的随访中,共发生499例死亡、540例MACE和140例骨折。在 Cox 比例危险模型中,G2、G3 和 G4 的全因死亡风险明显高于作为参照的 G1 {危险比:G2,2.16 [95%] G4,2.16 [95G2,2.16 [95% 置信区间(CI)1.65-2.84];G3,3.10 [95% CI 2.27-4.23];G4,3.11 [95% CI 1.89-5.14]}。同样,随着器官疾病数量的增加,发生MACE和骨折的风险也显著升高:结论:心血管-骨骼-肌肉轴的多种疾病是预测接受 HD 患者发病率和死亡率的重要因素。
Disturbance in the potential cardiovascular-bone-skeletal muscle axis and morbidity and mortality in patients undergoing haemodialysis: the Q-Cohort Study.
Background: Disturbances in the cardiovascular system, bone and skeletal muscle are independent risk factors for death among patients receiving haemodialysis (HD). However, the combined impact of disorders of these three organs on morbidity and mortality is unclear in the HD population.
Methods: A total of 3031 Japanese patients on maintenance HD were prospectively followed. The outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and bone fracture. Patients were divided into four groups (G1-G4) according to the baseline number of diseased organs represented as histories of cardiovascular disease and bone fractures and the presence of low skeletal muscle mass as follows: G1, no organ; G2, one organ; G3, two organs; G4, three organs. Multivariable-adjusted survival models were used to analyse associations between the number of diseased organs and outcomes.
Results: During a 4-year follow-up, 499 deaths, 540 MACE and 140 bone fractures occurred. In the Cox proportional hazards model, the risk for all-cause mortality was significantly higher in G2, G3 and G4 than in G1 as the reference {hazard ratio: G2, 2.16 [95% confidence interval (CI) 1.65-2.84], G3, 3.10 [95% CI 2.27-4.23] and G4, 3.11 [95% CI 1.89-5.14]}. Similarly, the risks for developing MACE and bone fractures were significantly elevated as the number of organ disorders increased.
Conclusions: Multiple disorders of the cardiovascular-bone-skeletal muscle axis are strong predictors of morbidity and mortality in patients undergoing HD.
期刊介绍:
About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.