Several studies have reported that lower body mass index (BMI) is associated with high mortality in patients with chronic kidney disease (CKD). Rate of infection-related death in CKD patients is increasing. However, the relationship between BMI and infection-related death is unclear. Overall, 2648 CKD outpatients (estimated glomerular filtration rate < 60 mL/min and/or presenting with proteinuria) under the care of nephrologists were prospectively followed for 5 years. Patients were stratified by quartile of BMI levels. Data on all-cause mortality before progression to end-stage kidney disease (ESKD) and the cause of death were collected. The median follow-up time was 3.9 years (interquartile range, 1.7–5.0); 114 patients died and 308 started renal replacement therapy. The leading causes of death were as follows; cardiovascular (41%), infection-related (21%), and malignancy-related (18%). Advanced age and lower BMI were the significant risk factors for all-cause mortality before progression to ESKD. Advanced age was statistically associated with respective causes of death, while lower BMI was associated with infection-related death only. CKD stage had no significant impact on all-cause or individual mortality. Low BMI was associated with significant risk of all-cause mortality and infection-related death, which may indicate the novel clinical target to improve CKD outcomes.

中文翻译：

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较低体重指数对日本慢性肾病患者全因死亡和感染相关死亡风险的影响。

几项研究报告称，较低的体重指数 (BMI) 与慢性肾病 (CKD) 患者的高死亡率相关。CKD 患者感染相关死亡率正在增加。然而，BMI与感染相关死亡之间的关系尚不清楚。总体而言，2648 名 CKD 门诊患者（估计肾小球滤过率 < 60 mL/min 和/或出现蛋白尿）在肾脏科医生的护理下进行了 5 年的前瞻性随访。患者按 BMI 水平的四分位数进行分层。收集了有关进展为终末期肾病 (ESKD) 之前的全因死亡率和死因的数据。中位随访时间为 3.9 年（四分位距，1.7-5.0）；114 名患者死亡，308 名患者开始肾脏替代治疗。主要死因如下：心血管（41%），感染相关 (21%) 和恶性肿瘤相关 (18%)。高龄和较低的 BMI 是进展为 ESKD 前全因死亡率的重要危险因素。高龄与各自的死亡原因在统计学上相关，而较低的 BMI 仅与感染相关死亡相关。CKD 分期对全因死亡率或个体死亡率没有显着影响。低 BMI 与全因死亡率和感染相关死亡的显着风险相关，这可能表明改善 CKD 结果的新临床目标。CKD 分期对全因死亡率或个体死亡率没有显着影响。低 BMI 与全因死亡率和感染相关死亡的显着风险相关，这可能表明改善 CKD 结果的新临床目标。CKD 分期对全因死亡率或个体死亡率没有显着影响。低 BMI 与全因死亡率和感染相关死亡的显着风险相关，这可能表明改善 CKD 结果的新临床目标。