Abstract：
Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations.
Prospective observational cohort study.
1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015.
The proportion of plant protein intake to total protein intake.
All-cause mortality and cardiovascular disease (CVD) mortality.
Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes.
The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion<45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%.
Observational study, potential unmeasured confounding.
There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population.
Prospective observational cohort study.
1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015.
The proportion of plant protein intake to total protein intake.
All-cause mortality and cardiovascular disease (CVD) mortality.
Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes.
The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion<45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%.
Observational study, potential unmeasured confounding.
There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population.
摘要：
尽管在接受维持性血液透析（MHD）的患者中，饮食中蛋白质的摄入量增加与有益的健康影响有关，植物蛋白摄入的影响不太确定。我们研究了接受MHD的患者中来自植物来源的蛋白质摄入比例与死亡风险的关联，并探讨了可能改变这些关联的因素。
前瞻性观察性队列研究。
2014-2015年1,119名年龄超过18岁的中国血液透析患者接受MHD。
植物蛋白摄入量占总蛋白摄入量的比例。
全因死亡率和心血管疾病(CVD)死亡率。
分段回归模型适用于检测植物蛋白摄入比例与全因死亡率和CVD死亡率风险的相关性。使用多变量校正的Cox比例和原因特异性风险模型来估计这些结果的风险比（HR）和95％CI。
以理想体重和植物蛋白摄入量比例归一化的植物蛋白摄入量平均值分别为每天0.6±0.2（SD）g/kg和0.538±0.134。在28.0个月的中位随访期内，发生249人死亡,这些死亡中有146人死于CVD。总的来说,植物蛋白摄入比例与全因死亡风险呈U型关系,拐点在45%。植物蛋白摄入比例<45%的患者中，植物蛋白摄入量每增加5%，死亡率降低17%(HR，0.83[95%CI，0.73-0.96]）。植物蛋白摄入比例≥45%的患者中,植物蛋白摄入量每增加5%，死亡率增加9%。对于CVD死亡率观察到类似的U形关联，拐点为44%。
观察性研究，潜在的无法测量的混淆。
在MHD患者中，植物蛋白摄入比例与全因死亡率和心血管死亡率之间存在U型关联。如果确认,这些发现提示了改善该患者人群结局的潜在途径.
前瞻性观察性队列研究。
2014-2015年1,119名年龄超过18岁的中国血液透析患者接受MHD。
植物蛋白摄入量占总蛋白摄入量的比例。
全因死亡率和心血管疾病(CVD)死亡率。
分段回归模型适用于检测植物蛋白摄入比例与全因死亡率和CVD死亡率风险的相关性。使用多变量校正的Cox比例和原因特异性风险模型来估计这些结果的风险比（HR）和95％CI。
以理想体重和植物蛋白摄入量比例归一化的植物蛋白摄入量平均值分别为每天0.6±0.2（SD）g/kg和0.538±0.134。在28.0个月的中位随访期内，发生249人死亡,这些死亡中有146人死于CVD。总的来说,植物蛋白摄入比例与全因死亡风险呈U型关系,拐点在45%。植物蛋白摄入比例<45%的患者中，植物蛋白摄入量每增加5%，死亡率降低17%(HR，0.83[95%CI，0.73-0.96]）。植物蛋白摄入比例≥45%的患者中,植物蛋白摄入量每增加5%，死亡率增加9%。对于CVD死亡率观察到类似的U形关联，拐点为44%。
观察性研究，潜在的无法测量的混淆。
在MHD患者中，植物蛋白摄入比例与全因死亡率和心血管死亡率之间存在U型关联。如果确认,这些发现提示了改善该患者人群结局的潜在途径.
