Association of body size with outcomes among patients beginning dialysis.
ABSTRACT Although obesity confers an increased risk of mortality in the general population, observational reports on the dialysis population have suggested that obesity is associated with improved survival. These reports have generally not examined extremely high values of body mass index (BMI; in kg/m(2)), survival >1 y, or alternative measures of adiposity.
We sought to clarify the relation between body size and outcomes among a large cohort of patients beginning dialysis.
Data on 418 055 patients beginning dialysis between 1 April 1995 and 1 November 2000 were analyzed by using US Renal Data System data. BMI was divided into 8 categories in increments of 3 units, ranging from < 19 to > or =37, and the relation between survival and BMI was examined by using proportional hazards regression with adjustment for demographic, laboratory, and comorbidity data.
High BMI was associated with increased survival in this cohort, even at extremely high BMI, after adjustment, and over a 2-y average follow-up time. This was true for whites, African Americans, and Hispanics but not for Asians. High BMI was also associated with a reduced risk of hospitalization and a lower rate of mortality in all mortality categories. Alternative estimates of adiposity, including the Benn index and estimated fat mass, yielded similar results, and adjustments for lean body mass did not substantially alter the findings.
High BMI is not associated with increased mortality among patients beginning dialysis. This finding does not appear to be a function of lean body mass and, although modified by certain patient characteristics, it is a robust finding.
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ABSTRACT: The obesity paradox is often attributed to fat acting as a buffer to protect individuals in fragile metabolic states. If this was the case, one would predict that the reverse epidemiology would be apparent across all causes of mortality including that of the particular disease state. We performed a dose-response meta-analysis to assess the impact of body mass index (BMI) on all-cause and stroke-specific mortality among stroke patients. Data from relevant studies were identified by systematically searching PubMed, OVID and Scopus databases and were analysed using a random-effects dose-response model. Eight cohort studies on all-cause mortality (with 20,807 deaths of 95,651 stroke patients) and nine studies of mortality exclusively because of stroke (with 8,087 deaths of 28,6270 patients) were evaluated in the meta-analysis. Non-linear associations of BMI with all-cause mortality (P < 0.0001) and mortality by stroke (P = 0.05) were observed. Among overweight and obese stroke patients, the risk of all-cause mortality increased, while the risk of mortality by stroke declined, with an increase in BMI. Increasing BMI had opposite effects on all-cause mortality and stroke-specific mortality in stroke patients. Further investigations are needed to examine how mortality by stroke is influenced by a more accurate indicator of obesity than BMI. © 2015 World Obesity.Obesity Reviews 04/2015; 16(5). DOI:10.1111/obr.12272 · 7.86 Impact Factor
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ABSTRACT: Background: Malnutrition, which is a powerful predictor of morbidity and mortality, is common in patients undergoing hemodialysis. Therefore, for a better overall outcome, adequate nutrition is very important for such patients. Objectives: The current study mainly aimed to investigate the relationship between nutritional markers, anthropometric parameters such as body mass index (BMI), and routine laboratory parameters with mortality in patients undergoing hemodialysis. Patients and Method: The demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, total protein, triglyceride, cholesterol, blood urea nitrogen (BUN), and creatinine of 260 patients treated from May 2001 to July 2011 were analyzed, retrospectively. The patients were followed-up regularly for one year. Lastly, the year follow-up was completed by 90 patients. Results: The results showed that statistically significant correlation between albumin serum levels (P = 0.001) and duration of hemodialysis (P = 0.001) with survival in patients undergoing hemodialysis. No statistically significant correlation was found between gender, BMI, triglyceride, cholesterol, BUN, and creatinine with survival in patients undergoing hemodialysis. Conclusions: The results of the current study suggested that low serum albumin levels and duration of hemodialysis were strong predictors of mortality and morbidity among patients undergoing hemodialysis.Shiraz E Medical Journal 05/2015; 16(2):1-5.
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ABSTRACT: Obesity is associated with chronic kidney disease progression. Whether metabolic risk factors modify this association is unclear. Here we examined associations of body mass index (BMI) and metabolic health with risk of end-stage renal disease (ESRD) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Among 21,840 participants eligible for analysis, 247 developed ESRD (mean follow-up of 6.3 years). Metabolic health significantly modified the association of BMI with ESRD. In models stratified by the presence or absence of the metabolic syndrome and adjusted for demographic, lifestyle, and clinical factors, higher BMI was associated with lower risk of ESRD in those without (hazard ratio per 5 kg/m(2) increase in BMI 0.70, 95% CI 0.52, 0.95) but not those with (hazard ratio, 1.06) the metabolic syndrome. In models stratified by weight and metabolic health, compared with normal weight (BMI 18.5-24.9 kg/m(2)) participants without the metabolic syndrome the overweight individuals (BMI 25-29.9) and obese individuals (BMI of 30 or more) with the metabolic syndrome had greater risk of ESRD (hazard ratios of 2.03 and 2.29, respectively), whereas obesity without the metabolic syndrome was associated with lower risk of ESRD (hazard ratio 0.47). Thus, higher BMI is associated with lower ESRD risk in those without but not those with the metabolic syndrome.Kidney International advance online publication, 17 December 2014; doi:10.1038/ki.2014.384.Kidney International 12/2014; DOI:10.1038/ki.2014.384 · 8.52 Impact Factor