Article

Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients.

Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
American Journal of Kidney Diseases (impact factor: 5.43). 06/2011; 58(4):574-82. DOI:10.1053/j.ajkd.2011.03.023 pp.574-82
Source: PubMed

ABSTRACT In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages. Given the greater survival of maintenance HD patients who are minorities, we hypothesized that increased body mass index (BMI) is associated more strongly with lower mortality in blacks and Hispanics relative to non-Hispanic whites.
Retrospective cohort study.
We examined a 6-year (2001-2007) cohort of 109,605 maintenance HD patients including 39,090 blacks, 17,417 Hispanics, and 53,098 non-Hispanic white maintenance HD outpatients from DaVita dialysis clinics. Cox proportional hazards models examined the association between BMI and survival.
Race and BMI.
All-cause mortality.
Patients had a mean age of 62 ± 15 (standard deviation) years and included 45% women and 45% patients with diabetes. Across 10 a priori-selected BMI categories (<18-≥40 kg/m(2)), higher BMI was associated with greater survival in all 3 racial/ethnic groups. However, Hispanic and black patients experienced higher survival gains compared with non-Hispanic whites across higher BMI categories. Hispanics and blacks in the ≥40-kg/m(2) category had the largest adjusted decrease in death HR with increasing BMI (0.57 [95% CI, 0.49-0.68] and 0.63 [95% CI, 0.58-0.70], respectively) compared with non-Hispanic whites in the 23- to 25-kg/m(2) group (reference category). In linear models, although the inverse BMI-mortality association was observed for all subgroups, overall black maintenance HD patients showed the largest consistent decrease in death HR with increasing BMI.
Race and ethnicity categories were based on self-identified data.
Whereas the survival advantage of high BMI is consistent across all racial/ethnic groups, black maintenance HD patients had the strongest and most consistent association of higher BMI with improved survival.

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Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

109,605 maintenance HD patients
 
3 racial/ethnic groups
 
black maintenance HD patients
 
black patients
 
Cox proportional hazards models
 
DaVita dialysis clinics
 
death HR
 
ethnicity categories
 
greater survival
 
higher BMI
 
higher BMI categories
 
higher survival gains
 
increased body mass index
 
largest consistent decrease
 
linear models
 
maintenance HD patients
 
maintenance hemodialysis
 
priori-selected BMI categories
 
Retrospective cohort study
 
survival advantages