Abstract：
Interdialytic weight gain (IDWG) is crucial in the association between long interdialytic intervals and mortality in hemodialysis patients. The impact of IDWG on changes in residual kidney function (RKF) has not been evaluated thoroughly. This study examined the associations of IDWG in the long intervals (IDWGL) with mortality and rapid RKF decline.
This retrospective cohort study included patients who initiated hemodialysis in the United States dialysis centers from 2007 to 2011. IDWGL was defined as IDWG in the two-day break between dialysis sessions. This study examined the associations of seven categories of IDWGL (0% to <1%, 1% to <2%, 2% to <3% [reference], 3% to <4%, 4% to <5%, 5% to <6%, and ≥6%) with mortality using Cox regression models and rapid decline of renal urea clearance (KRU) using logistic regression models. The continuous relationships between IDWGL and study outcomes were investigated using restricted cubic spline analyses.
Mortality and rapid RKF decline were assessed in 35,225 and 6425 patients, respectively. Higher IDWGL categories were linked to increased risk of adverse outcomes. The multivariate adjusted hazard ratios (95% confidence intervals) of all-cause mortality for 3% to <4%, 4% to <5%, 5% to <6%, and ≥6% IDWGL were 1.09 (1.02-1.16), 1.14 (1.06-1.22), 1.16 (1.06-1.28), and 1.25 (1.13-1.37), respectively. The multivariate adjusted odds ratios (95% confidence intervals) of rapid decline of KRU for 3% to <4%, 4% to <5%, 5% to <6%, and ≥6% IDWGL were 1.03 (0.90-1.19), 1.29 (1.08-1.55), 1.17 (0.92-1.49), and 1.48 (1.13-1.95), respectively. When IDWGL exceeded 2%, the hazard ratios of mortality and the odds ratios of rapid KRU decline continuously increased.
Higher IDWGL was incrementally associated with higher mortality risk and rapid KRU decline. IDWGL level over 2% was linked to higher risk of adverse outcomes. Therefore, IDWGL may be utilized as a risk parameter for mortality and RKF decline.
This retrospective cohort study included patients who initiated hemodialysis in the United States dialysis centers from 2007 to 2011. IDWGL was defined as IDWG in the two-day break between dialysis sessions. This study examined the associations of seven categories of IDWGL (0% to <1%, 1% to <2%, 2% to <3% [reference], 3% to <4%, 4% to <5%, 5% to <6%, and ≥6%) with mortality using Cox regression models and rapid decline of renal urea clearance (KRU) using logistic regression models. The continuous relationships between IDWGL and study outcomes were investigated using restricted cubic spline analyses.
Mortality and rapid RKF decline were assessed in 35,225 and 6425 patients, respectively. Higher IDWGL categories were linked to increased risk of adverse outcomes. The multivariate adjusted hazard ratios (95% confidence intervals) of all-cause mortality for 3% to <4%, 4% to <5%, 5% to <6%, and ≥6% IDWGL were 1.09 (1.02-1.16), 1.14 (1.06-1.22), 1.16 (1.06-1.28), and 1.25 (1.13-1.37), respectively. The multivariate adjusted odds ratios (95% confidence intervals) of rapid decline of KRU for 3% to <4%, 4% to <5%, 5% to <6%, and ≥6% IDWGL were 1.03 (0.90-1.19), 1.29 (1.08-1.55), 1.17 (0.92-1.49), and 1.48 (1.13-1.95), respectively. When IDWGL exceeded 2%, the hazard ratios of mortality and the odds ratios of rapid KRU decline continuously increased.
Higher IDWGL was incrementally associated with higher mortality risk and rapid KRU decline. IDWGL level over 2% was linked to higher risk of adverse outcomes. Therefore, IDWGL may be utilized as a risk parameter for mortality and RKF decline.
摘要：
背景：透析间期体重增加（IDWG）在透析患者长的透析间期和死亡率之间的关系中至关重要。IDWG对残余肾功能（RKF）变化的影响尚未得到彻底评估。这项研究检查了长间隔（IDWGL）中IDWG与死亡率和RKF快速下降的关系。
方法：这项回顾性队列研究包括2007年至2011年在美国透析中心开始血液透析的患者。IDWGL在透析疗程之间的两天休息时间被定义为IDWG。本研究检查了七类IDWGL的关联(0%至<1%，1%到<2%，2%到<3%[参考]，3%至<4%，4%至<5%，5%至<6%，和≥6％），使用Cox回归模型的死亡率和使用逻辑回归模型的肾尿素清除率（KRU）的快速下降。使用有限的三次样条分析研究了IDWGL与研究结果之间的连续关系。
结果：在35,225和6425例患者中评估了死亡率和快速RKF下降，分别。较高的IDWGL类别与不良后果的风险增加有关。3％至<4％的全因死亡率的多变量调整风险比（95％置信区间），4%至<5%，5%至<6%，IDWGL≥6%为1.09(1.02-1.16)，1.14(1.06-1.22),1.16(1.06-1.28),和1.25（1.13-1.37），分别。KRU快速下降3%至<4%的多变量调整优势比(95%置信区间)，4%至<5%，5%至<6%，IDWGL≥6%为1.03(0.90-1.19)，1.29(1.08-1.55),1.17（0.92-1.49），和1.48（1.13-1.95），分别。当IDWGL超过2%时,死亡率的危险比和KRU快速下降的比值比持续增加.
结论：较高的IDWGL与较高的死亡风险和KRU快速下降相关。IDWGL水平超过2%与较高的不良后果风险有关。因此,IDWGL可用作死亡率和RKF下降的风险参数。
方法：这项回顾性队列研究包括2007年至2011年在美国透析中心开始血液透析的患者。IDWGL在透析疗程之间的两天休息时间被定义为IDWG。本研究检查了七类IDWGL的关联(0%至<1%，1%到<2%，2%到<3%[参考]，3%至<4%，4%至<5%，5%至<6%，和≥6％），使用Cox回归模型的死亡率和使用逻辑回归模型的肾尿素清除率（KRU）的快速下降。使用有限的三次样条分析研究了IDWGL与研究结果之间的连续关系。
结果：在35,225和6425例患者中评估了死亡率和快速RKF下降，分别。较高的IDWGL类别与不良后果的风险增加有关。3％至<4％的全因死亡率的多变量调整风险比（95％置信区间），4%至<5%，5%至<6%，IDWGL≥6%为1.09(1.02-1.16)，1.14(1.06-1.22),1.16(1.06-1.28),和1.25（1.13-1.37），分别。KRU快速下降3%至<4%的多变量调整优势比(95%置信区间)，4%至<5%，5%至<6%，IDWGL≥6%为1.03(0.90-1.19)，1.29(1.08-1.55),1.17（0.92-1.49），和1.48（1.13-1.95），分别。当IDWGL超过2%时,死亡率的危险比和KRU快速下降的比值比持续增加.
结论：较高的IDWGL与较高的死亡风险和KRU快速下降相关。IDWGL水平超过2%与较高的不良后果风险有关。因此,IDWGL可用作死亡率和RKF下降的风险参数。
