- 期刊
The Association of the Lean Tissue Index With 10-Year Survival Between Sexes in Peritoneal Dialysis Patients
摘要
Body composition analysis can be used to assess the clinical status of peritoneal dialysis (PD) patients. Reduced skeletal muscle mass is commonly observed in dialysis patients and is associated with increased mortality. Early detection of a low lean tissue index (LTI) and early intervention could be considered critical strategies for improving the survival rates of these patients. However, males typically have a greater proportion of lean mass than females. Therefore, this study aimed to investigate the impact of sex differences in the LTI on long-term survival in PD patients. This retrospective study included 282 PD patients who underwent initial body composition analysis using bioimpedance spectroscopy between May 2012 and March 2018. Patients were followed-up until they died, after they withdrew from PD, or at the end of April 2023. The primary outcome was all-cause mortality. This study included 150 males with an average LTI of 14.5 ± 3.1 kg/m^2, which was greater than the average LTI of 11.5 ± 2.2 kg/m^2 for the 132 included females (p < 0.001). There was no difference in the Kaplan-Meier survival curves between males and females (p = 0.55). Regarding the LTI, the hazard ratios (95% confidence intervals) for all-cause mortality were 0.76 (0.67-0.87) for males and 0.84 (0.72-0.98) for females (both p < 0.05). After adjusting for confounders, age, diabetes mellitus, relative overhydration, and the LTI were independently associated with all-cause mortality in females, whereas only the LTI independently predicted mortality in males. A low LTI in both sexes (< 11.9 kg/m^2 in females and < 12.1 kg/m^2 in males) was independently associated with a 3-fold greater risk of death than a high LTI in PD patients. Regardless of sex, the LTI was a significant factor that influenced the survival of PD patients. It might be advisable that female patients maintain an LTI above 11.9 kg/ m^2 and that male patients maintain an LTI above 12.1 kg/m^2 to achieve better survival rates.