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제목	Metabolically Abnormal Non-obese Phenotype is Significantly Associated with Increased Mortality in Incident Dialysis Patients
저자	Hae-Ryong Yun* 1, Hyoungnae Kim1, Seohyun Park1, Su-Young Jung1, Jong Hyun Jhee1, Chang-Yun Yoon1, Youn Kyung Kee1, Young Eun Kwon1, Jung Tak Park1, Seung Hyeok Han1, Shin-Wook Kang1, Yong-Lim Kim2, Yon Su Kim3, Chul Woo Yang4, Nam-Ho Kim5, Tae-Hyun Yoo1
출판정보	2016; 2016(1):
키워드	Dialysis patients, Metabolically abnormal non-obese phenotype , Mortality
초록	Background: In patients with normal renal function, metabolically abnormal obesity is associated with high all-cause mortality, however, paradoxically inverse association between obesity and mortality was usually observed in dialysis population. Therefore, to investigate whether the concept of metabolic unhealthiness with obesity might be applicable in dialysis patients, we performed the post hoc analysis of a prospective cohort study. Methods: During 2009 and 2013, Total 1,141 Patients who started dialysis were prospectively recruited from the Clinical Research Center for End Stage Renal Disease (CRC-ESRD) data set. Metabolic abnormality was determined by the presence of 2 or more of the following: 1) HbA1c ≥6.5% or history of diabetes, 2) Triglyceride ≥150 mg/dL, 3) High-density lipoprotein cholesterol ≤40 mg/dL in men or ≤50 mg/dL in women,4) High-sensitivity C-reactive protein ≥3 mg/L. Obesity was defined by body mass index ≥25.0 kg/m². Patients were divided into four groups (metabolically healthy obesity [MHO], metabolically healthy non-obesity [MHNO], metabolically abnormal obesity [MAO], and metabolically abnormal non-obesity [MANO]) according to metabolic status and obesity. Cox proportional hazard analysis was performed to determine association between metabolic healthy obesity phenotype and all-cause of mortality. Results: The mean age of the study population was 56.5±13.9 years and 705 (61.8%) patients were male. A 63 (5.5%), 316 (27.7%), 240 (21.0%), and 522 (45.7%) patients were classified into MHO, MHNO, MAO, and MANO group, respectively. MANO group showed significantly older (54.0±14.7 vs. 53.2±15.3 vs. 56.2±12.6 vs. 58.9±12.9 years, P<0.001) and lower serum albumin level (3.5±0.5 vs. 3.4±0.6 vs. 3.3±0.03 vs. 3.1±0.5 g/dL, P<0.001). During a median follow-up duration of 20.0 (6.2-36.4) months, all-cause mortality was observed with 5 (7.9%), 43 (13.6%), 35 (14.5%), and 148 (28.3%) patients in MHO, MHNO, MAO, and MANO groups, respectively. In Cox proportional hazard analysis, MANO group showed significantly higher all-cause mortality events (hazard ratio, 2.700; 95% confidence interval, 1.09-6.64; P=0.031) even after adjustment for age, sex, smoking status, systolic blood pressure, diastolic blood pressure, serum albumin, calcium, phosphate, uric acid, and total cholesterol, while the other groups did not showed significant differences. Conclusion: MANO group was significantly associated with higher mortality compared to MAO as well as MHO or MHNO in dialysis patients. Obese phenotype stratified metabolic abnormality in dialysis patients is substantially different from that in general population.
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